| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
9,413 |
9,325 |
$419K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,865 |
5,027 |
$261K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,823 |
1,823 |
$215K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,113 |
2,113 |
$209K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,134 |
1,980 |
$101K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,210 |
1,137 |
$73K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
2,917 |
2,174 |
$49K |
| 92015 |
Determination of refractive state |
1,392 |
1,392 |
$22K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
365 |
336 |
$20K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
262 |
240 |
$20K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
296 |
255 |
$13K |