| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2500 |
Contact lens, pmma, spherical, per lens |
775 |
753 |
$453K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,958 |
2,921 |
$94K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,780 |
1,690 |
$62K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,312 |
2,037 |
$51K |
| V2020 |
Frames, purchases |
2,959 |
2,891 |
$35K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
331 |
319 |
$12K |
| 92002 |
|
234 |
234 |
$6K |
| 92310 |
|
47 |
42 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
113 |
57 |
$655.20 |
| 92082 |
|
14 |
14 |
$487.47 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,342 |
694 |
$337.60 |
| 92015 |
Determination of refractive state |
184 |
184 |
$331.00 |
| 92225 |
|
17 |
15 |
$286.22 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
20 |
20 |
$200.00 |