| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
10,039 |
5,055 |
$139K |
| V2020 |
Frames, purchases |
9,630 |
9,469 |
$114K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,106 |
4,096 |
$106K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
2,519 |
1,249 |
$45K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,196 |
2,196 |
$34K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,868 |
1,926 |
$19K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,168 |
583 |
$9K |
| 68761 |
|
26 |
13 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
111 |
111 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
91 |
91 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
26 |
26 |
$644.00 |
| 92002 |
|
34 |
34 |
$520.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
72 |
36 |
$164.32 |
| 92015 |
Determination of refractive state |
3,247 |
3,240 |
$0.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
28 |
14 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,108 |
3,009 |
$0.00 |
| V2755 |
U-v lens, per lens |
72 |
35 |
$0.00 |