| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,475 |
1,310 |
$114K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,398 |
1,018 |
$87K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,601 |
1,598 |
$64K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,484 |
1,484 |
$59K |
| V2020 |
Frames, purchases |
2,546 |
2,383 |
$51K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
277 |
265 |
$21K |
| V2025 |
Deluxe frame |
1,086 |
1,059 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
270 |
270 |
$11K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
155 |
141 |
$10K |
| V2750 |
Anti-reflective coating, per lens |
1,099 |
889 |
$6K |
| V2599 |
Contact lens, other type |
54 |
54 |
$5K |
| V2744 |
Tint, photochromatic, per lens |
310 |
257 |
$3K |
| V2760 |
Scratch resistant coating, per lens |
364 |
253 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
749 |
329 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
13 |
$1K |
| V2781 |
Progressive lens, per lens |
124 |
102 |
$1K |
| V2799 |
Vision item or service, miscellaneous |
149 |
145 |
$900.00 |