| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
11,058 |
6,779 |
$158K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,210 |
4,198 |
$145K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,072 |
3,003 |
$142K |
| V2020 |
Frames, purchases |
8,931 |
8,708 |
$82K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
553 |
543 |
$31K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,272 |
1,264 |
$17K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,406 |
2,285 |
$12K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
537 |
529 |
$9K |
| 92250 |
|
170 |
170 |
$8K |
| 92015 |
Determination of refractive state |
910 |
907 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
868 |
433 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
101 |
51 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
47 |
47 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$240.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
24 |
12 |
$123.24 |
| 3072F |
|
73 |
70 |
$0.00 |