| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92002 |
|
2,627 |
2,627 |
$78K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,121 |
5,116 |
$73K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,167 |
1,780 |
$57K |
| V2020 |
Frames, purchases |
7,299 |
7,281 |
$54K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,618 |
2,624 |
$34K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
441 |
439 |
$32K |
| V2199 |
Not otherwise classified, single vision lens |
1,684 |
841 |
$31K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,737 |
2,707 |
$30K |
| 92250 |
|
442 |
440 |
$24K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
353 |
353 |
$11K |
| 92341 |
|
318 |
318 |
$6K |
| 92202 |
|
330 |
329 |
$3K |
| 92225 |
|
103 |
102 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
75 |
38 |
$2K |
| 92286 |
|
40 |
40 |
$941.48 |
| 92083 |
|
15 |
15 |
$877.95 |
| 76514 |
|
103 |
103 |
$866.21 |
| 92025 |
|
59 |
59 |
$446.54 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$276.00 |
| 92285 |
|
12 |
12 |
$235.64 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$199.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$155.64 |
| V2750 |
Anti-reflective coating, per lens |
161 |
81 |
$0.00 |