| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,403 |
1,196 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,295 |
1,096 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
374 |
368 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
171 |
168 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,142 |
928 |
$604.02 |
| 92015 |
Determination of refractive state |
949 |
916 |
$435.00 |
| 92342 |
|
251 |
249 |
$100.70 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
12 |
$86.72 |
| 92341 |
|
13 |
12 |
$48.36 |
| 2022F |
|
213 |
213 |
$0.00 |
| V2025 |
Deluxe frame |
26 |
26 |
$0.00 |
| V2756 |
Eye glass case |
249 |
247 |
$0.00 |
| 3072F |
|
133 |
133 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
54 |
27 |
$0.00 |