| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,719 |
1,844 |
$97K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
1,133 |
547 |
$65K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,851 |
925 |
$54K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
541 |
244 |
$43K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
625 |
307 |
$42K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,177 |
1,633 |
$39K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,501 |
1,739 |
$36K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
621 |
288 |
$17K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
491 |
227 |
$16K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
273 |
111 |
$8K |
| 92015 |
Determination of refractive state |
1,299 |
611 |
$7K |
| V2781 |
Progressive lens, per lens |
105 |
105 |
$5K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
138 |
71 |
$5K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
99 |
47 |
$4K |
| V2750 |
Anti-reflective coating, per lens |
147 |
147 |
$2K |
| 92341 |
|
289 |
117 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
75 |
32 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
94 |
94 |
$575.30 |