| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2199 |
Not otherwise classified, single vision lens |
1,462 |
731 |
$29K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
851 |
431 |
$17K |
| V2020 |
Frames, purchases |
1,594 |
1,582 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
269 |
269 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
201 |
201 |
$8K |
| 92002 |
|
161 |
161 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
150 |
148 |
$6K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
24 |
12 |
$688.76 |
| V2299 |
Specialty bifocal (by report) |
24 |
12 |
$628.76 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
25 |
25 |
$210.00 |
| 92015 |
Determination of refractive state |
14 |
14 |
$209.40 |
| V2750 |
Anti-reflective coating, per lens |
600 |
299 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,760 |
878 |
$0.00 |