| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
10,703 |
10,438 |
$944K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
5,213 |
5,115 |
$557K |
| V2020 |
Frames, purchases |
13,794 |
13,475 |
$232K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
9,853 |
9,697 |
$194K |
| V2025 |
Deluxe frame |
4,865 |
4,849 |
$149K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,958 |
4,878 |
$99K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
3,224 |
3,166 |
$64K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,297 |
2,274 |
$45K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
579 |
562 |
$20K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
809 |
788 |
$16K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
138 |
134 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
131 |
128 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
54 |
54 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
225 |
224 |
$2K |
| 92310 |
|
122 |
120 |
$664.00 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
16 |
16 |
$345.10 |
| V2744 |
Tint, photochromatic, per lens |
19 |
19 |
$128.03 |