| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,418 |
1,324 |
$64K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,752 |
1,673 |
$60K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
656 |
634 |
$40K |
| 92015 |
Determination of refractive state |
2,430 |
2,329 |
$16K |
| V2020 |
Frames, purchases |
1,282 |
1,205 |
$16K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,816 |
1,709 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
373 |
344 |
$13K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
25 |
25 |
$502.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
174 |
172 |
$0.00 |
| 92341 |
|
27 |
27 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
48 |
46 |
$0.00 |
| V2025 |
Deluxe frame |
976 |
908 |
$-297.00 |