| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,308 |
4,268 |
$172K |
| 92004 |
|
2,837 |
2,801 |
$169K |
| 92014 |
|
2,772 |
2,749 |
$146K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,186 |
2,106 |
$133K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
573 |
572 |
$67K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
972 |
933 |
$37K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,662 |
1,656 |
$32K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
195 |
195 |
$14K |
| 92015 |
|
1,251 |
1,217 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
140 |
140 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
110 |
110 |
$5K |
| 92340 |
|
232 |
225 |
$4K |
| 92012 |
|
34 |
34 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
12 |
12 |
$30.00 |