| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,580 |
1,384 |
$43K |
| V2020 |
Frames, purchases |
4,295 |
4,194 |
$42K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,044 |
1,040 |
$23K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
514 |
513 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,356 |
722 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
327 |
321 |
$11K |
| 92002 |
|
342 |
341 |
$8K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
277 |
136 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
43 |
43 |
$820.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
69 |
41 |
$641.96 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
15 |
14 |
$210.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,846 |
915 |
$136.00 |
| V2755 |
U-v lens, per lens |
2,138 |
1,050 |
$0.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
28 |
14 |
$0.00 |