| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,192 |
4,123 |
$113K |
| V2020 |
Frames, purchases |
3,897 |
3,848 |
$101K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,274 |
2,165 |
$92K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,067 |
1,047 |
$43K |
| V2025 |
Deluxe frame |
601 |
600 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,139 |
4,080 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
329 |
329 |
$18K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
294 |
290 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
54 |
54 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$674.25 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$66.96 |
| 92015 |
Determination of refractive state |
3,633 |
3,465 |
$0.00 |
| V2755 |
U-v lens, per lens |
12 |
12 |
$0.00 |