| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,737 |
3,720 |
$53K |
| 92002 |
|
1,060 |
1,059 |
$41K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,878 |
1,839 |
$39K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
659 |
659 |
$24K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,508 |
1,507 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
303 |
299 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
516 |
471 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
299 |
297 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,582 |
1,369 |
$7K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
398 |
398 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
13 |
$750.64 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
27 |
25 |
$292.68 |
| V2755 |
U-v lens, per lens |
288 |
144 |
$0.00 |