| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,909 |
2,763 |
$113K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,868 |
2,723 |
$110K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,258 |
2,123 |
$46K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,733 |
2,605 |
$45K |
| V2750 |
Anti-reflective coating, per lens |
40 |
38 |
$743.90 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
61 |
57 |
$632.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
147 |
119 |
$517.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
34 |
33 |
$345.18 |
| V2799 |
Vision item or service, miscellaneous |
63 |
60 |
$0.00 |