| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,885 |
1,883 |
$153K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
499 |
499 |
$30K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
800 |
799 |
$27K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
667 |
664 |
$20K |
| 92015 |
Determination of refractive state |
586 |
586 |
$9K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
135 |
135 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
388 |
388 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
36 |
36 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
25 |
25 |
$850.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$780.00 |