| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
9,163 |
9,095 |
$243K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
4,597 |
4,493 |
$225K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
4,179 |
4,077 |
$192K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
6,729 |
6,669 |
$117K |
| 92341 |
|
2,224 |
2,206 |
$46K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,991 |
2,983 |
$34K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,280 |
3,243 |
$28K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,601 |
2,570 |
$26K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
943 |
934 |
$15K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
824 |
818 |
$10K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
204 |
204 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
25 |
25 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
166 |
163 |
$1K |
| V2756 |
Eye glass case |
3,771 |
3,757 |
$632.70 |
| V2750 |
Anti-reflective coating, per lens |
315 |
311 |
$311.20 |
| 92342 |
|
12 |
12 |
$296.56 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$153.30 |
| V2025 |
Deluxe frame |
766 |
764 |
$0.00 |
| 3072F |
|
33 |
29 |
$0.00 |
| V2781 |
Progressive lens, per lens |
62 |
62 |
$0.00 |
| V2755 |
U-v lens, per lens |
41 |
40 |
$0.00 |