| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,732 |
5,554 |
$180K |
| V2744 |
Tint, photochromatic, per lens |
6,731 |
5,554 |
$152K |
| 92015 |
Determination of refractive state |
4,217 |
3,931 |
$144K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
5,204 |
4,367 |
$136K |
| V2110 |
Spherocylinder, single vision, plus or minus 4.25 to 7.00d sphere, over 6.00d cylinder, per lens |
2,912 |
2,459 |
$128K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,239 |
2,103 |
$102K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,040 |
4,231 |
$99K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,278 |
1,213 |
$79K |
| V2112 |
Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens |
1,199 |
1,033 |
$72K |
| V2210 |
Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens |
678 |
590 |
$54K |
| 92341 |
|
1,486 |
1,317 |
$32K |
| V2109 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens |
683 |
593 |
$31K |
| V2113 |
Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens |
62 |
53 |
$4K |
| V2209 |
Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens |
37 |
32 |
$2K |
| V2212 |
Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens |
14 |
14 |
$1K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
18 |
16 |
$676.94 |