| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
7,486 |
7,409 |
$322K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,007 |
3,944 |
$199K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,757 |
1,736 |
$94K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
3,522 |
3,503 |
$74K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,187 |
1,182 |
$72K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
775 |
768 |
$39K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
237 |
234 |
$14K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
31 |
30 |
$3K |
| 92015 |
Determination of refractive state |
14 |
14 |
$0.00 |