| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
11,169 |
10,679 |
$420K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,772 |
4,377 |
$151K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,513 |
2,386 |
$148K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
3,273 |
3,149 |
$144K |
| 92015 |
Determination of refractive state |
11,724 |
11,048 |
$63K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
538 |
497 |
$45K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,210 |
1,123 |
$40K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
4,323 |
4,136 |
$39K |
| 92002 |
|
768 |
750 |
$39K |
| V2755 |
U-v lens, per lens |
2,052 |
2,000 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
110 |
77 |
$4K |
| 92250 |
|
41 |
39 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
44 |
25 |
$1K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
12 |
12 |
$993.84 |
| V2760 |
Scratch resistant coating, per lens |
69 |
66 |
$676.76 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
12 |
$414.15 |