| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13,092 |
7,601 |
$209K |
| V2020 |
Frames, purchases |
11,911 |
11,665 |
$176K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,435 |
3,415 |
$108K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
3,283 |
1,957 |
$72K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
574 |
573 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
10,622 |
5,588 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,385 |
731 |
$9K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
464 |
251 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
304 |
301 |
$1K |
| 92341 |
|
67 |
65 |
$740.00 |
| 92002 |
|
16 |
16 |
$625.20 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
83 |
44 |
$370.64 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
13 |
13 |
$240.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
20 |
12 |
$81.08 |
| V2755 |
U-v lens, per lens |
5,417 |
2,660 |
$0.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
120 |
60 |
$0.00 |
| 92015 |
Determination of refractive state |
57 |
56 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
24 |
12 |
$0.00 |