| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
11,166 |
6,404 |
$349K |
| V2020 |
Frames, purchases |
8,319 |
8,199 |
$312K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
7,479 |
7,352 |
$303K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,161 |
2,141 |
$95K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,402 |
786 |
$60K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
742 |
737 |
$22K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,852 |
3,595 |
$18K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
486 |
477 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
241 |
240 |
$10K |
| V2781 |
Progressive lens, per lens |
198 |
121 |
$5K |
| 92015 |
Determination of refractive state |
1,256 |
1,240 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
431 |
427 |
$4K |
| V2299 |
Specialty bifocal (by report) |
67 |
37 |
$3K |
| V2025 |
Deluxe frame |
204 |
202 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
70 |
37 |
$2K |