| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
770 |
641 |
$33K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
155 |
142 |
$25K |
| 92014 |
|
440 |
410 |
$25K |
| 92004 |
|
314 |
300 |
$16K |
| V2020 |
Frames, purchases |
396 |
319 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
153 |
149 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
122 |
120 |
$5K |
| V2025 |
Deluxe frame |
469 |
458 |
$5K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
71 |
58 |
$4K |
| 92340 |
|
76 |
63 |
$984.84 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
93 |
76 |
$549.57 |
| 92015 |
|
276 |
243 |
$49.10 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$0.00 |
| S0581 |
Nonstandard lens (list this code in addition to the basic code for the lens) |
36 |
35 |
$0.00 |