| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,906 |
1,829 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
548 |
309 |
$9K |
| V2199 |
Not otherwise classified, single vision lens |
1,812 |
899 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
210 |
210 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
143 |
143 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
290 |
289 |
$3K |
| V2299 |
Specialty bifocal (by report) |
180 |
90 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
56 |
28 |
$400.12 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
14 |
$348.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$290.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
61 |
31 |
$205.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
777 |
392 |
$62.00 |
| V2750 |
Anti-reflective coating, per lens |
161 |
81 |
$9.00 |