| Code | Description | Claims | Beneficiaries | Total Paid |
| V2020 |
Frames, purchases |
7,079 |
6,818 |
$272K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,956 |
2,873 |
$163K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
1,752 |
1,615 |
$129K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,622 |
3,527 |
$95K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,378 |
1,253 |
$73K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
472 |
459 |
$64K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
848 |
832 |
$44K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
393 |
378 |
$39K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,488 |
1,403 |
$37K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
926 |
913 |
$22K |
| 92015 |
Determination of refractive state |
1,312 |
1,258 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
81 |
77 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
252 |
243 |
$9K |
| 92250 |
|
100 |
89 |
$6K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
322 |
296 |
$6K |
| V2025 |
Deluxe frame |
35 |
35 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
147 |
125 |
$2K |
| 92083 |
|
12 |
12 |
$693.12 |
| 92133 |
|
12 |
12 |
$470.40 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
12 |
$165.00 |