| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,058 |
3,951 |
$143K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,438 |
1,390 |
$93K |
| V2020 |
Frames, purchases |
3,367 |
3,252 |
$62K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
695 |
681 |
$55K |
| 92015 |
Determination of refractive state |
3,572 |
2,916 |
$38K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,080 |
2,989 |
$19K |
| V2025 |
Deluxe frame |
636 |
630 |
$18K |
| V2750 |
Anti-reflective coating, per lens |
860 |
852 |
$16K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
200 |
200 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
399 |
397 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$325.00 |
| V2755 |
U-v lens, per lens |
49 |
49 |
$141.54 |