| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,167 |
1,065 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
716 |
417 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
226 |
202 |
$14K |
| 92015 |
Determination of refractive state |
859 |
794 |
$13K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
270 |
134 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
244 |
244 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
454 |
219 |
$5K |
| 92370 |
|
298 |
142 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
45 |
45 |
$3K |
| V2750 |
Anti-reflective coating, per lens |
272 |
136 |
$3K |
| V2755 |
U-v lens, per lens |
156 |
78 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
100 |
46 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
56 |
42 |
$1K |
| 92285 |
|
24 |
24 |
$783.37 |