| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,022 |
3,012 |
$85K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
746 |
741 |
$52K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,514 |
1,205 |
$39K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
617 |
596 |
$37K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,790 |
1,789 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,005 |
875 |
$19K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
335 |
335 |
$6K |
| 92002 |
|
342 |
341 |
$5K |
| 92015 |
Determination of refractive state |
1,766 |
1,733 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
62 |
62 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,549 |
901 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
32 |
32 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
88 |
88 |
$936.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
46 |
42 |
$616.77 |
| 92341 |
|
13 |
13 |
$40.00 |
| 92370 |
|
31 |
31 |
$0.04 |