| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,643 |
4,489 |
$143K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,010 |
2,892 |
$139K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,801 |
1,731 |
$87K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,121 |
3,079 |
$57K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,477 |
1,448 |
$40K |
| 92015 |
Determination of refractive state |
2,686 |
2,578 |
$26K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,597 |
1,539 |
$17K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,155 |
1,103 |
$10K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
100 |
95 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
103 |
100 |
$3K |
| V2760 |
Scratch resistant coating, per lens |
111 |
111 |
$2K |
| 92341 |
|
16 |
16 |
$485.01 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
39 |
39 |
$382.79 |
| V2025 |
Deluxe frame |
70 |
70 |
$70.00 |