| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,350 |
3,137 |
$139K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,876 |
1,866 |
$135K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,469 |
1,266 |
$131K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,068 |
1,068 |
$128K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,430 |
1,421 |
$126K |
| 92015 |
Determination of refractive state |
1,168 |
1,165 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
533 |
531 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
37 |
37 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17 |
13 |
$510.00 |