| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
1,794 |
1,785 |
$88K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,439 |
1,428 |
$61K |
| V2020 |
Frames, purchases |
1,814 |
1,602 |
$51K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,948 |
976 |
$49K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
604 |
601 |
$32K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,955 |
1,116 |
$25K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
354 |
318 |
$11K |
| V2750 |
Anti-reflective coating, per lens |
530 |
258 |
$8K |
| 92285 |
|
628 |
587 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
157 |
119 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
70 |
59 |
$1K |
| V2299 |
Specialty bifocal (by report) |
28 |
12 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
34 |
15 |
$940.00 |
| 92083 |
|
15 |
15 |
$894.16 |
| V2781 |
Progressive lens, per lens |
29 |
13 |
$800.00 |
| 92133 |
|
15 |
15 |
$494.36 |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
19 |
16 |
$380.00 |
| V2760 |
Scratch resistant coating, per lens |
23 |
12 |
$195.00 |