| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,555 |
2,545 |
$116K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
782 |
781 |
$108K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
555 |
553 |
$92K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,956 |
1,947 |
$53K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
824 |
734 |
$27K |
| V2025 |
Deluxe frame |
340 |
340 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
534 |
486 |
$17K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,423 |
1,157 |
$16K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
168 |
167 |
$10K |
| 92015 |
Determination of refractive state |
1,490 |
1,488 |
$10K |
| 92025 |
|
15 |
15 |
$607.69 |
| V2750 |
Anti-reflective coating, per lens |
24 |
24 |
$0.00 |