| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,627 |
3,606 |
$83K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,687 |
1,667 |
$63K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,216 |
1,203 |
$50K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,248 |
1,248 |
$49K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,106 |
2,088 |
$37K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
787 |
787 |
$31K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,763 |
1,740 |
$26K |
| 92015 |
Determination of refractive state |
3,028 |
3,006 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
401 |
401 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
785 |
781 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
46 |
46 |
$736.98 |
| V2750 |
Anti-reflective coating, per lens |
27 |
27 |
$334.30 |
| V2199 |
Not otherwise classified, single vision lens |
17 |
17 |
$212.50 |
| V2025 |
Deluxe frame |
17 |
17 |
$170.00 |