| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,290 |
2,267 |
$57K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,150 |
1,150 |
$49K |
| V2020 |
Frames, purchases |
2,584 |
2,560 |
$43K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
822 |
820 |
$35K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,950 |
1,926 |
$19K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
79 |
79 |
$3K |
| V2299 |
Specialty bifocal (by report) |
53 |
53 |
$2K |
| 92310 |
|
15 |
15 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
513 |
509 |
$0.00 |
| 92015 |
Determination of refractive state |
322 |
321 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
158 |
154 |
$0.00 |
| V2781 |
Progressive lens, per lens |
53 |
53 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
12 |
12 |
$0.00 |