| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
19,723 |
10,636 |
$320K |
| V2020 |
Frames, purchases |
16,221 |
15,903 |
$187K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
4,087 |
2,216 |
$86K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,784 |
1,948 |
$37K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,096 |
552 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13,288 |
6,973 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
491 |
484 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
647 |
336 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
223 |
216 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
97 |
94 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
121 |
62 |
$1K |
| V2755 |
U-v lens, per lens |
138 |
67 |
$0.00 |
| V2756 |
Eye glass case |
33 |
33 |
$0.00 |
| 92015 |
Determination of refractive state |
376 |
366 |
$0.00 |
| 2022F |
|
36 |
36 |
$0.00 |