| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,717 |
1,567 |
$97K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,432 |
1,338 |
$82K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,183 |
1,111 |
$54K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
1,079 |
983 |
$11K |
| 92015 |
Determination of refractive state |
2,631 |
2,442 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,671 |
1,557 |
$6K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
74 |
68 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
729 |
692 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
48 |
$637.52 |
| V2755 |
U-v lens, per lens |
1,773 |
1,625 |
$547.89 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
441 |
423 |
$396.96 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
100 |
85 |
$107.92 |
| V2025 |
Deluxe frame |
16 |
12 |
$101.12 |