| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,514 |
4,715 |
$124K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,862 |
2,119 |
$120K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,324 |
2,257 |
$95K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,922 |
1,888 |
$78K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,615 |
1,025 |
$56K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
808 |
481 |
$34K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
469 |
310 |
$21K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
306 |
306 |
$12K |
| V2115 |
Lenticular, (myodisc), per lens, single vision |
110 |
96 |
$10K |
| 92002 |
|
197 |
196 |
$8K |
| V2781 |
Progressive lens, per lens |
567 |
305 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
182 |
125 |
$6K |
| V2025 |
Deluxe frame |
83 |
83 |
$4K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
63 |
39 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
356 |
202 |
$375.00 |
| V2750 |
Anti-reflective coating, per lens |
96 |
64 |
$303.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
13 |
$0.00 |