| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,316 |
1,314 |
$63K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
878 |
850 |
$39K |
| V2020 |
Frames, purchases |
1,518 |
1,466 |
$35K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,018 |
2,004 |
$30K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
789 |
748 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
215 |
208 |
$11K |
| 92015 |
Determination of refractive state |
223 |
217 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,249 |
1,102 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
930 |
898 |
$501.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
15 |
12 |
$60.00 |
| V2750 |
Anti-reflective coating, per lens |
19 |
18 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
28 |
$0.00 |