| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,056 |
1,056 |
$51K |
| V2020 |
Frames, purchases |
1,231 |
1,171 |
$30K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,828 |
1,796 |
$27K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
856 |
777 |
$20K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
204 |
200 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
92 |
90 |
$6K |
| 92015 |
Determination of refractive state |
164 |
155 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
669 |
630 |
$520.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
631 |
624 |
$145.00 |