| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,695 |
1,964 |
$66K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,091 |
1,087 |
$40K |
| V2020 |
Frames, purchases |
2,821 |
2,811 |
$34K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
894 |
894 |
$32K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
369 |
189 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,906 |
1,490 |
$1K |
| 92015 |
Determination of refractive state |
36 |
36 |
$364.80 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
15 |
15 |
$225.00 |