| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,229 |
5,225 |
$248K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,337 |
4,333 |
$223K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,628 |
2,599 |
$165K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,153 |
2,134 |
$128K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,200 |
2,198 |
$103K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,517 |
1,515 |
$49K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
453 |
453 |
$40K |
| 92250 |
|
1,096 |
1,096 |
$35K |
| V2760 |
Scratch resistant coating, per lens |
268 |
268 |
$9K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
67 |
67 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
65 |
65 |
$4K |
| 92326 |
|
39 |
39 |
$3K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
12 |
12 |
$1K |
| 92015 |
Determination of refractive state |
140 |
140 |
$0.00 |