| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,559 |
2,549 |
$103K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,692 |
1,642 |
$92K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
930 |
929 |
$51K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
719 |
690 |
$46K |
| 92015 |
Determination of refractive state |
688 |
635 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
205 |
205 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
25 |
25 |
$446.50 |
| V2760 |
Scratch resistant coating, per lens |
14 |
14 |
$72.40 |