| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,364 |
1,362 |
$78K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,106 |
1,086 |
$56K |
| V2020 |
Frames, purchases |
583 |
583 |
$52K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
877 |
876 |
$31K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
620 |
620 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
369 |
366 |
$21K |
| 92015 |
Determination of refractive state |
933 |
923 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
40 |
$2K |
| 92250 |
|
111 |
109 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
12 |
$287.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$200.00 |