| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,423 |
4,908 |
$96K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,901 |
3,533 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,884 |
1,722 |
$9K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
580 |
543 |
$8K |
| 92341 |
|
1,313 |
1,213 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,551 |
1,381 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
83 |
83 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
64 |
64 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
565 |
502 |
$612.55 |
| V2025 |
Deluxe frame |
26 |
13 |
$246.48 |
| 92015 |
Determination of refractive state |
189 |
189 |
$0.00 |
| 2022F |
|
179 |
179 |
$0.00 |
| G0117 |
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
189 |
189 |
$0.00 |