| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,569 |
1,569 |
$133K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,311 |
2,181 |
$133K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,549 |
1,395 |
$82K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,007 |
949 |
$52K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
402 |
402 |
$43K |
| V2020 |
Frames, purchases |
669 |
668 |
$23K |
| 92015 |
Determination of refractive state |
1,224 |
1,021 |
$9K |
| V2760 |
Scratch resistant coating, per lens |
589 |
589 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
115 |
103 |
$5K |
| 92250 |
|
239 |
184 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
408 |
408 |
$4K |
| 92083 |
|
13 |
12 |
$550.61 |
| 92133 |
|
15 |
13 |
$372.52 |
| 92082 |
|
25 |
14 |
$205.75 |