| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,986 |
2,480 |
$54K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,333 |
1,329 |
$53K |
| V2199 |
Not otherwise classified, single vision lens |
1,618 |
602 |
$43K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,257 |
582 |
$40K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
633 |
622 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,724 |
1,392 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
413 |
230 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
355 |
348 |
$14K |
| V2299 |
Specialty bifocal (by report) |
205 |
104 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
121 |
54 |
$4K |
| 92015 |
Determination of refractive state |
587 |
587 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
172 |
90 |
$120.00 |
| V2750 |
Anti-reflective coating, per lens |
123 |
61 |
$40.00 |