| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,782 |
5,761 |
$188K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
885 |
881 |
$98K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,491 |
2,428 |
$89K |
| V2025 |
Deluxe frame |
2,293 |
2,278 |
$87K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,586 |
5,545 |
$62K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
609 |
602 |
$58K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,300 |
2,039 |
$57K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
767 |
753 |
$42K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
400 |
400 |
$29K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,691 |
2,222 |
$27K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
507 |
422 |
$14K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
335 |
331 |
$12K |
| 92341 |
|
317 |
314 |
$12K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
149 |
149 |
$5K |
| 92015 |
Determination of refractive state |
1,540 |
1,538 |
$4K |
| V2744 |
Tint, photochromatic, per lens |
45 |
45 |
$800.00 |
| 2023F |
|
28 |
28 |
$0.00 |
| 3072F |
|
12 |
12 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
12 |
12 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
42 |
42 |
$0.00 |