| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
11,272 |
10,241 |
$226K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,468 |
2,467 |
$123K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,983 |
5,344 |
$117K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,220 |
2,201 |
$90K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,497 |
1,496 |
$74K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,010 |
1,774 |
$38K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,523 |
2,488 |
$35K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,079 |
944 |
$19K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
301 |
297 |
$10K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
503 |
441 |
$8K |
| V2025 |
Deluxe frame |
775 |
775 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
474 |
430 |
$3K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
12 |
12 |
$708.00 |
| V2781 |
Progressive lens, per lens |
16 |
16 |
$382.00 |
| V2744 |
Tint, photochromatic, per lens |
39 |
39 |
$96.90 |
| V2755 |
U-v lens, per lens |
12 |
12 |
$96.00 |
| V2799 |
Vision item or service, miscellaneous |
323 |
286 |
$10.00 |
| 3072F |
|
148 |
148 |
$0.00 |
| 92015 |
Determination of refractive state |
3,422 |
3,420 |
$0.00 |
| 2022F |
|
55 |
55 |
$0.00 |