| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
20,262 |
18,603 |
$537K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16,537 |
10,003 |
$456K |
| V2755 |
U-v lens, per lens |
20,980 |
11,703 |
$223K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
7,735 |
4,688 |
$211K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
7,128 |
4,618 |
$202K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
3,457 |
2,163 |
$112K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
7,670 |
7,083 |
$89K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
1,155 |
854 |
$46K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
936 |
637 |
$32K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
713 |
456 |
$22K |
| V2109 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens |
196 |
172 |
$14K |
| V2111 |
Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens |
228 |
148 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
72 |
70 |
$7K |
| 92015 |
Determination of refractive state |
342 |
333 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
51 |
49 |
$4K |
| V2114 |
Spherocylinder, single vision, sphere over plus or minus 12.00d, per lens |
35 |
25 |
$3K |
| V2112 |
Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens |
34 |
25 |
$2K |