| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,590 |
1,549 |
$50K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,057 |
1,031 |
$44K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,121 |
1,098 |
$36K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
163 |
160 |
$7K |
| 92015 |
Determination of refractive state |
317 |
304 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
168 |
167 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
113 |
109 |
$880.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
26 |
$7.00 |
| V2025 |
Deluxe frame |
14 |
14 |
$0.00 |