| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,628 |
1,572 |
$64K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
773 |
719 |
$61K |
| V2025 |
Deluxe frame |
856 |
811 |
$58K |
| 92015 |
Determination of refractive state |
1,275 |
1,245 |
$39K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,383 |
2,266 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
379 |
366 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
306 |
285 |
$19K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
271 |
255 |
$13K |
| V2020 |
Frames, purchases |
1,203 |
1,148 |
$8K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$1K |