| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,249 |
2,248 |
$111K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,101 |
1,091 |
$63K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
4,112 |
4,080 |
$62K |
| V2020 |
Frames, purchases |
2,033 |
1,982 |
$31K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
454 |
440 |
$26K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,279 |
1,142 |
$19K |
| 92015 |
Determination of refractive state |
1,115 |
1,088 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,012 |
1,883 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,719 |
1,681 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
98 |
93 |
$160.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
52 |
50 |
$50.00 |
| V2750 |
Anti-reflective coating, per lens |
57 |
57 |
$0.00 |