| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,978 |
4,344 |
$233K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,620 |
3,542 |
$156K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
5,037 |
1,435 |
$137K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,734 |
1,462 |
$129K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,283 |
2,229 |
$98K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
258 |
129 |
$10K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
290 |
88 |
$8K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
138 |
68 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,012 |
578 |
$2K |
| V2299 |
Specialty bifocal (by report) |
24 |
12 |
$908.00 |
| V2781 |
Progressive lens, per lens |
24 |
12 |
$720.00 |
| 92015 |
Determination of refractive state |
1,384 |
1,378 |
$40.00 |