| Code | Description | Claims | Beneficiaries | Total Paid |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,717 |
3,248 |
$204K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,327 |
3,269 |
$149K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
2,075 |
961 |
$93K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,809 |
2,040 |
$68K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
785 |
773 |
$45K |
| V2020 |
Frames, purchases |
3,818 |
3,612 |
$27K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,724 |
975 |
$26K |
| 92015 |
Determination of refractive state |
3,603 |
3,534 |
$20K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
795 |
438 |
$17K |
| 92083 |
|
145 |
144 |
$8K |
| 92310 |
|
181 |
175 |
$7K |
| 92020 |
|
533 |
531 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
93 |
92 |
$4K |
| 92133 |
|
133 |
132 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
187 |
91 |
$4K |
| 92134 |
|
120 |
119 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
103 |
94 |
$3K |
| 92250 |
|
69 |
68 |
$3K |
| V2025 |
Deluxe frame |
418 |
416 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
161 |
101 |
$3K |
| V2302 |
Sphere, trifocal, plus or minus 7.12 to plus or minus 20.00, per lens |
24 |
12 |
$600.00 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
24 |
13 |
$420.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$323.51 |
| V2781 |
Progressive lens, per lens |
39 |
24 |
$0.00 |