| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16,170 |
7,325 |
$509K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
10,824 |
10,637 |
$434K |
| V2020 |
Frames, purchases |
11,186 |
9,435 |
$413K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
2,247 |
1,264 |
$96K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
786 |
761 |
$32K |
| V2744 |
Tint, photochromatic, per lens |
776 |
409 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
672 |
280 |
$18K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
448 |
447 |
$18K |
| V2781 |
Progressive lens, per lens |
671 |
363 |
$15K |
| V2299 |
Specialty bifocal (by report) |
391 |
186 |
$14K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
148 |
75 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
10,070 |
3,702 |
$4K |
| V2025 |
Deluxe frame |
322 |
310 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
79 |
35 |
$2K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
26 |
14 |
$720.00 |
| V2750 |
Anti-reflective coating, per lens |
23 |
13 |
$297.00 |
| 2022F |
|
143 |
142 |
$0.00 |