| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
7,436 |
3,699 |
$151K |
| V2020 |
Frames, purchases |
5,079 |
5,047 |
$109K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,052 |
2,052 |
$82K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,868 |
1,868 |
$74K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,331 |
667 |
$37K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
138 |
126 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,296 |
2,137 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
32 |
16 |
$656.48 |
| V2299 |
Specialty bifocal (by report) |
50 |
25 |
$143.32 |
| V2755 |
U-v lens, per lens |
1,500 |
746 |
$0.00 |
| V2781 |
Progressive lens, per lens |
50 |
25 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
24 |
12 |
$0.00 |
| 92015 |
Determination of refractive state |
42 |
42 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
78 |
39 |
$0.00 |