| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,978 |
3,644 |
$146K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,984 |
3,682 |
$145K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,097 |
1,949 |
$133K |
| 92015 |
Determination of refractive state |
5,748 |
5,336 |
$34K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,126 |
1,027 |
$32K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,395 |
4,951 |
$32K |
| V2020 |
Frames, purchases |
4,165 |
3,816 |
$29K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
452 |
401 |
$13K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
171 |
153 |
$7K |
| V2599 |
Contact lens, other type |
64 |
55 |
$7K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
41 |
41 |
$2K |
| 92310 |
|
120 |
113 |
$915.00 |
| 92341 |
|
210 |
191 |
$351.54 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
549 |
507 |
$35.00 |
| V2750 |
Anti-reflective coating, per lens |
301 |
260 |
$0.00 |
| V2025 |
Deluxe frame |
1,958 |
1,810 |
$-65.00 |