| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,082 |
3,058 |
$120K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,167 |
2,152 |
$119K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,862 |
1,803 |
$99K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,794 |
1,782 |
$96K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
783 |
770 |
$59K |
| 92250 |
|
700 |
689 |
$37K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
453 |
449 |
$34K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
600 |
590 |
$20K |
| 92015 |
Determination of refractive state |
1,108 |
1,079 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
490 |
467 |
$19K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
248 |
241 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
286 |
256 |
$12K |
| V2781 |
Progressive lens, per lens |
27 |
27 |
$770.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
639 |
639 |
$707.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$565.00 |