| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2219 |
Bifocal seg width over 28 mm |
1,377 |
1,189 |
$107K |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
841 |
729 |
$92K |
| V2430 |
Variable asphericity lens, bifocal, full field, glass or plastic, per lens |
1,432 |
1,243 |
$80K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
134 |
119 |
$40K |
| V2020 |
Frames, purchases |
4,198 |
3,797 |
$29K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
430 |
368 |
$25K |
| 92341 |
|
1,308 |
1,166 |
$23K |
| V2319 |
Trifocal seg width over 28 mm |
439 |
392 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,306 |
1,190 |
$18K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
804 |
725 |
$12K |
| 92342 |
|
551 |
462 |
$10K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
265 |
226 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
309 |
216 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
142 |
130 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
305 |
254 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
275 |
140 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
451 |
382 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
154 |
71 |
$4K |
| 92015 |
Determination of refractive state |
38 |
38 |
$528.00 |
| 92226 |
|
14 |
14 |
$378.00 |
| V2755 |
U-v lens, per lens |
238 |
117 |
$0.00 |