| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,106 |
1,096 |
$25K |
| V2020 |
Frames, purchases |
1,574 |
1,554 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
623 |
614 |
$24K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
325 |
325 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
804 |
793 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
36 |
36 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
24 |
24 |
$884.60 |
| 92015 |
Determination of refractive state |
1,994 |
1,958 |
$666.56 |