| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,854 |
1,720 |
$53K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
486 |
456 |
$45K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
602 |
543 |
$42K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,778 |
1,624 |
$32K |
| 92015 |
Determination of refractive state |
1,304 |
1,191 |
$12K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
156 |
150 |
$8K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
59 |
53 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
141 |
139 |
$230.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
360 |
334 |
$195.00 |
| V2750 |
Anti-reflective coating, per lens |
108 |
99 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
25 |
24 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
98 |
87 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
15 |
15 |
$0.00 |