| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
24,253 |
23,185 |
$591K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14,197 |
12,865 |
$332K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,864 |
1,844 |
$176K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,847 |
1,832 |
$127K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
3,219 |
2,844 |
$103K |
| V2110 |
Spherocylinder, single vision, plus or minus 4.25 to 7.00d sphere, over 6.00d cylinder, per lens |
1,683 |
1,594 |
$76K |
| 92015 |
Determination of refractive state |
4,184 |
4,146 |
$62K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,455 |
1,426 |
$37K |
| V2756 |
Eye glass case |
22,064 |
21,217 |
$23K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,391 |
1,328 |
$21K |
| 92002 |
|
241 |
238 |
$14K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
261 |
259 |
$13K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
336 |
318 |
$11K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
245 |
243 |
$6K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
65 |
62 |
$2K |
| V2781 |
Progressive lens, per lens |
27 |
26 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
14 |
13 |
$794.00 |
| V2205 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
13 |
13 |
$443.28 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
27 |
27 |
$436.00 |