| 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 |
5,559 |
3,951 |
$822K |
| V2025 |
Deluxe frame |
10,403 |
8,573 |
$658K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
7,271 |
6,675 |
$486K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
5,308 |
4,965 |
$443K |
| V2020 |
Frames, purchases |
13,000 |
10,620 |
$234K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13,932 |
11,113 |
$232K |
| V2760 |
Scratch resistant coating, per lens |
14,572 |
11,061 |
$223K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
17,044 |
14,279 |
$206K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,764 |
3,990 |
$62K |
| V2781 |
Progressive lens, per lens |
433 |
400 |
$50K |
| V2715 |
Prism, per lens |
4,239 |
3,091 |
$43K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,610 |
2,127 |
$42K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,726 |
1,316 |
$27K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
31 |
30 |
$23K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
1,199 |
896 |
$22K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
278 |
251 |
$15K |
| V2730 |
Special base curve, glass or plastic, per lens |
608 |
479 |
$12K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
2,573 |
2,325 |
$11K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
134 |
119 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
69 |
55 |
$3K |
| V2106 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens |
34 |
33 |
$2K |
| V2799 |
Vision item or service, miscellaneous |
133 |
115 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
108 |
99 |
$1K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
16 |
13 |
$270.20 |
| V2756 |
Eye glass case |
15 |
13 |
$50.40 |
| V2755 |
U-v lens, per lens |
46 |
43 |
$0.00 |
| V2780 |
Oversize lens, per lens |
28 |
24 |
$0.00 |
| 92015 |
Determination of refractive state |
12 |
12 |
$0.00 |