| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
505 |
447 |
$87K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
639 |
595 |
$50K |
| V2025 |
Deluxe frame |
672 |
616 |
$43K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
432 |
412 |
$30K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,002 |
1,837 |
$25K |
| V2020 |
Frames, purchases |
1,249 |
1,139 |
$19K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,060 |
956 |
$18K |
| V2760 |
Scratch resistant coating, per lens |
1,166 |
1,019 |
$18K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
1,167 |
1,019 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
425 |
395 |
$8K |
| 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 |
$287.82 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
14 |
$273.60 |