| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,712 |
1,098 |
$50K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,286 |
887 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,482 |
962 |
$30K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,129 |
706 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
253 |
137 |
$733.32 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,711 |
1,136 |
$316.50 |
| 92015 |
Determination of refractive state |
2,846 |
1,929 |
$225.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
39 |
17 |
$224.36 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
15 |
12 |
$87.18 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
759 |
495 |
$64.36 |
| 92325 |
Contact lens gas impermeable |
137 |
61 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
53 |
52 |
$0.00 |