| Code | Description | Claims | Beneficiaries | Total Paid |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
10,573 |
9,903 |
$250K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
17,741 |
16,739 |
$164K |
| V2020 |
Frames, purchases |
14,576 |
13,752 |
$143K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,361 |
4,092 |
$93K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,895 |
1,756 |
$72K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
2,966 |
2,767 |
$66K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
848 |
794 |
$58K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
1,521 |
1,415 |
$43K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,285 |
1,220 |
$32K |
| 92341 |
|
1,658 |
1,581 |
$15K |
| V2599 |
Contact lens, other type |
133 |
126 |
$14K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
386 |
355 |
$10K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
335 |
312 |
$7K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
213 |
198 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,068 |
3,856 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
141 |
131 |
$5K |
| V2111 |
Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens |
70 |
65 |
$2K |
| 92310 |
|
107 |
103 |
$335.00 |
| 92015 |
Determination of refractive state |
2,798 |
2,602 |
$273.50 |
| 92342 |
|
46 |
46 |
$46.50 |
| V2756 |
Eye glass case |
45 |
45 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
308 |
299 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
13 |
13 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
812 |
753 |
$0.00 |
| V2025 |
Deluxe frame |
6,114 |
5,845 |
$-147.00 |