| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
19,910 |
8,315 |
$548K |
| V2020 |
Frames, purchases |
10,826 |
9,104 |
$462K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
7,090 |
6,966 |
$319K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,529 |
4,447 |
$200K |
| 92250 |
|
1,356 |
1,335 |
$71K |
| V2750 |
Anti-reflective coating, per lens |
1,462 |
586 |
$32K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16,760 |
6,696 |
$26K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
685 |
614 |
$24K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
149 |
149 |
$11K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
90 |
81 |
$9K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
105 |
105 |
$5K |
| V2781 |
Progressive lens, per lens |
119 |
61 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
487 |
477 |
$5K |
| V2299 |
Specialty bifocal (by report) |
116 |
58 |
$4K |
| 92015 |
Determination of refractive state |
829 |
807 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
75 |
39 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
48 |
24 |
$2K |
| 2025F |
|
196 |
192 |
$30.00 |
| 2023F |
|
33 |
27 |
$0.00 |