| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,096 |
1,900 |
$83K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,010 |
945 |
$59K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,028 |
941 |
$38K |
| 92250 |
|
467 |
431 |
$17K |
| 92015 |
Determination of refractive state |
2,174 |
2,020 |
$11K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
1,170 |
1,069 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
107 |
104 |
$10K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
122 |
115 |
$5K |
| V2760 |
Scratch resistant coating, per lens |
96 |
93 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
26 |
24 |
$624.71 |
| 92133 |
|
24 |
24 |
$349.32 |