| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
5,477 |
3,092 |
$136K |
| V2020 |
Frames, purchases |
4,035 |
3,937 |
$92K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,794 |
1,790 |
$75K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
555 |
554 |
$25K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,137 |
1,137 |
$17K |
| 92002 |
|
262 |
262 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
120 |
120 |
$8K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
188 |
108 |
$7K |
| 92015 |
Determination of refractive state |
686 |
686 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,959 |
1,584 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
120 |
59 |
$2K |
| 92250 |
|
33 |
33 |
$2K |
| 92341 |
|
50 |
50 |
$1K |
| V2756 |
Eye glass case |
260 |
259 |
$0.00 |