| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,854 |
2,684 |
$118K |
| 92370 |
|
5,270 |
3,592 |
$116K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,683 |
2,718 |
$91K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,614 |
1,532 |
$75K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
647 |
608 |
$67K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
664 |
634 |
$63K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,064 |
1,938 |
$49K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,060 |
1,009 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
224 |
216 |
$19K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
554 |
523 |
$18K |
| 92015 |
Determination of refractive state |
1,117 |
1,070 |
$14K |
| 99072 |
|
704 |
467 |
$14K |
| 92341 |
|
39 |
32 |
$1K |
| 92342 |
|
25 |
21 |
$718.13 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$269.51 |