| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
5,416 |
4,989 |
$394K |
| V2219 |
Bifocal seg width over 28 mm |
3,612 |
3,348 |
$314K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,905 |
2,699 |
$262K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,618 |
3,336 |
$240K |
| V2760 |
Scratch resistant coating, per lens |
5,152 |
4,746 |
$156K |
| 92341 |
|
4,546 |
4,379 |
$148K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
1,204 |
1,120 |
$138K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
908 |
883 |
$121K |
| V2799 |
Vision item or service, miscellaneous |
309 |
292 |
$84K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
991 |
896 |
$69K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,372 |
2,289 |
$64K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
690 |
617 |
$38K |
| V2215 |
Lenticular (myodisc), per lens, bifocal |
190 |
189 |
$32K |
| V2780 |
Oversize lens, per lens |
915 |
858 |
$17K |
| V2020 |
Frames, purchases |
267 |
262 |
$15K |
| 92015 |
Determination of refractive state |
600 |
578 |
$14K |
| V2781 |
Progressive lens, per lens |
72 |
72 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
163 |
149 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
45 |
40 |
$4K |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
30 |
30 |
$4K |
| V2744 |
Tint, photochromatic, per lens |
153 |
146 |
$4K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
35 |
34 |
$4K |
| 92370 |
|
60 |
60 |
$2K |
| G0117 |
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
13 |
12 |
$696.36 |