| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
10,501 |
9,314 |
$511K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
18,395 |
8,090 |
$508K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
7,089 |
6,963 |
$315K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,761 |
1,721 |
$78K |
| V2750 |
Anti-reflective coating, per lens |
3,784 |
1,675 |
$72K |
| V2744 |
Tint, photochromatic, per lens |
1,460 |
653 |
$48K |
| V2299 |
Specialty bifocal (by report) |
864 |
413 |
$33K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
732 |
354 |
$28K |
| V2781 |
Progressive lens, per lens |
864 |
413 |
$28K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14,112 |
5,937 |
$9K |
| 2022F |
|
781 |
754 |
$0.00 |
| 92015 |
Determination of refractive state |
30 |
29 |
$0.00 |