| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
3,220 |
3,219 |
$153K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
6,001 |
5,925 |
$88K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,464 |
1,435 |
$66K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,062 |
1,032 |
$55K |
| V2020 |
Frames, purchases |
2,985 |
2,887 |
$39K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,560 |
1,447 |
$26K |
| 92015 |
Determination of refractive state |
1,316 |
1,275 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,906 |
2,818 |
$2K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
144 |
70 |
$790.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$693.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,670 |
2,600 |
$679.50 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
498 |
467 |
$400.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
320 |
301 |
$384.00 |
| V2702 |
Deluxe lens feature |
60 |
60 |
$36.00 |
| V2744 |
Tint, photochromatic, per lens |
12 |
12 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
128 |
128 |
$0.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
16 |
15 |
$0.00 |