| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
1,735 |
1,704 |
$56K |
| 92014 |
|
5,531 |
5,515 |
$51K |
| 92004 |
|
5,417 |
5,402 |
$37K |
| 92012 |
|
692 |
627 |
$19K |
| 92340 |
|
1,194 |
1,189 |
$15K |
| 92225 |
|
506 |
302 |
$12K |
| 92015 |
|
2,121 |
2,118 |
$7K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
548 |
548 |
$4K |
| 99203 |
|
65 |
65 |
$4K |
| 92273 |
|
89 |
86 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
9,622 |
5,279 |
$3K |
| V2020 |
Frames, purchases |
6,677 |
6,620 |
$3K |
| 99213 |
|
94 |
93 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
7,557 |
4,064 |
$2K |
| 92083 |
|
24 |
24 |
$438.39 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
151 |
88 |
$130.00 |
| V2299 |
Specialty bifocal (by report) |
203 |
123 |
$0.00 |
| V2781 |
Progressive lens, per lens |
221 |
135 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
817 |
449 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
74 |
74 |
$0.00 |
| V2599 |
Contact lens, other type |
39 |
39 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
122 |
63 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
1,830 |
965 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
81 |
81 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
12 |
12 |
$0.00 |