| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,802 |
1,765 |
$32K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,053 |
1,038 |
$24K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
856 |
839 |
$10K |
| 92015 |
Determination of refractive state |
387 |
381 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
79 |
74 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
52 |
52 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
41 |
41 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$515.52 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$348.32 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |