| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,120 |
1,211 |
$38K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
604 |
581 |
$27K |
| 92081 |
|
846 |
840 |
$26K |
| V2020 |
Frames, purchases |
1,672 |
1,660 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
237 |
231 |
$14K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
379 |
378 |
$5K |
| 92015 |
Determination of refractive state |
150 |
150 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
19 |
12 |
$450.48 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$97.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
380 |
188 |
$12.00 |