| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
7,846 |
7,701 |
$185K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,586 |
3,533 |
$99K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,493 |
5,409 |
$94K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,648 |
2,618 |
$38K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
757 |
757 |
$33K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
701 |
699 |
$30K |
| V2025 |
Deluxe frame |
599 |
597 |
$17K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
185 |
185 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
524 |
519 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,927 |
2,867 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
138 |
138 |
$4K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
242 |
239 |
$3K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
40 |
39 |
$562.50 |
| 92015 |
Determination of refractive state |
12 |
12 |
$240.00 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$127.50 |
| V2750 |
Anti-reflective coating, per lens |
75 |
75 |
$0.00 |