| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,994 |
3,916 |
$167K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,091 |
2,060 |
$150K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,110 |
2,079 |
$149K |
| V2025 |
Deluxe frame |
1,992 |
1,971 |
$108K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,298 |
5,187 |
$87K |
| V2020 |
Frames, purchases |
3,308 |
3,240 |
$74K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
869 |
869 |
$63K |
| 92015 |
Determination of refractive state |
3,005 |
2,970 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
603 |
582 |
$7K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
12 |
$685.80 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
25 |
25 |
$201.28 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
18 |
18 |
$192.00 |