| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,649 |
822 |
$23K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
579 |
579 |
$16K |
| V2020 |
Frames, purchases |
1,912 |
1,873 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
125 |
124 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
206 |
205 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
59 |
59 |
$820.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
140 |
70 |
$780.52 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
13 |
$750.64 |
| 92002 |
|
17 |
17 |
$117.52 |
| V2755 |
U-v lens, per lens |
290 |
143 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,162 |
562 |
$0.00 |