| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,155 |
5,067 |
$147K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,633 |
2,872 |
$145K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,965 |
1,955 |
$130K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,301 |
1,291 |
$119K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,503 |
1,486 |
$69K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
415 |
394 |
$28K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
786 |
404 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
276 |
138 |
$6K |
| 92341 |
|
234 |
233 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,333 |
3,157 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
27 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
53 |
53 |
$795.00 |
| 92015 |
Determination of refractive state |
27 |
27 |
$342.67 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
13 |
13 |
$260.00 |
| 2022F |
|
13 |
13 |
$0.00 |