| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,312 |
1,717 |
$101K |
| 92004 |
|
1,526 |
1,486 |
$67K |
| V2025 |
Deluxe frame |
2,575 |
2,021 |
$64K |
| 92340 |
|
2,245 |
2,211 |
$60K |
| 92015 |
|
2,885 |
2,840 |
$46K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
920 |
607 |
$39K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
233 |
115 |
$39K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,588 |
1,559 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,147 |
1,126 |
$14K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
170 |
168 |
$8K |
| V2020 |
Frames, purchases |
322 |
303 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
68 |
67 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
108 |
108 |
$1K |
| 92341 |
|
27 |
27 |
$789.03 |
| 92310 |
|
14 |
14 |
$700.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
43 |
41 |
$490.40 |
| 92250 |
|
30 |
28 |
$0.00 |
| S0581 |
Nonstandard lens (list this code in addition to the basic code for the lens) |
16 |
16 |
$0.00 |