| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
2,134 |
1,415 |
$329K |
| V2025 |
Deluxe frame |
2,912 |
1,902 |
$284K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,282 |
1,243 |
$148K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,884 |
1,236 |
$85K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
772 |
748 |
$79K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,799 |
1,840 |
$76K |
| V2020 |
Frames, purchases |
1,007 |
605 |
$66K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,927 |
1,915 |
$53K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
110 |
79 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
57 |
39 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
16 |
13 |
$386.56 |
| 92015 |
Determination of refractive state |
76 |
75 |
$0.00 |