| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,596 |
4,912 |
$268K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,510 |
3,319 |
$240K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
968 |
868 |
$225K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
940 |
873 |
$178K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
2,782 |
1,802 |
$49K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
804 |
679 |
$36K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
6,173 |
4,562 |
$34K |
| 92015 |
Determination of refractive state |
2,267 |
2,062 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
65 |
61 |
$7K |
| 92341 |
|
167 |
144 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
79 |
72 |
$470.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$345.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
774 |
453 |
$45.00 |
| V2755 |
U-v lens, per lens |
499 |
352 |
$0.00 |