| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
712 |
681 |
$30K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
323 |
262 |
$22K |
| 92012 |
|
435 |
374 |
$20K |
| V2020 |
Frames, purchases |
528 |
528 |
$18K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
48 |
14 |
$9K |
| 92004 |
|
174 |
146 |
$8K |
| 92015 |
|
614 |
614 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
416 |
416 |
$5K |
| V2025 |
Deluxe frame |
265 |
177 |
$3K |
| 92340 |
|
143 |
143 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
16 |
16 |
$720.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
14 |
14 |
$630.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
39 |
$408.32 |
| V2799 |
Vision item or service, miscellaneous |
15 |
15 |
$0.00 |
| S0581 |
Nonstandard lens (list this code in addition to the basic code for the lens) |
13 |
13 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
57 |
19 |
$0.00 |