| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,768 |
2,724 |
$32K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
745 |
743 |
$26K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,138 |
1,064 |
$26K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,428 |
713 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
610 |
608 |
$9K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
210 |
207 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
310 |
155 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
72 |
72 |
$2K |
| V2755 |
U-v lens, per lens |
890 |
445 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,610 |
803 |
$0.00 |