| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,918 |
2,883 |
$69K |
| V2020 |
Frames, purchases |
3,499 |
3,448 |
$63K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,436 |
1,435 |
$58K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
853 |
849 |
$35K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
369 |
362 |
$10K |
| 92015 |
Determination of refractive state |
105 |
105 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
111 |
52 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
699 |
688 |
$4K |
| 92060 |
|
26 |
26 |
$796.26 |
| V2781 |
Progressive lens, per lens |
13 |
13 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
12 |
12 |
$0.00 |
| 99072 |
|
21 |
16 |
$0.00 |
| V2025 |
Deluxe frame |
18 |
18 |
$0.00 |