| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,626 |
4,909 |
$98K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,672 |
2,138 |
$19K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,002 |
933 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,600 |
2,173 |
$9K |
| V2025 |
Deluxe frame |
272 |
246 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,068 |
1,004 |
$7K |
| V2500 |
Contact lens, pmma, spherical, per lens |
266 |
133 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
1,813 |
1,504 |
$772.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
45 |
34 |
$280.67 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
15 |
15 |
$209.98 |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
22 |
12 |
$141.01 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$27.50 |
| 92342 |
|
28 |
14 |
$20.00 |
| V2744 |
Tint, photochromatic, per lens |
24 |
13 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
255 |
187 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
44 |
44 |
$0.00 |
| V2781 |
Progressive lens, per lens |
58 |
16 |
$0.00 |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
20 |
12 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
175 |
150 |
$0.00 |