| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
18,800 |
8,731 |
$514K |
| V2020 |
Frames, purchases |
10,488 |
9,728 |
$410K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
6,752 |
6,409 |
$303K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
6,651 |
6,387 |
$288K |
| 92250 |
|
1,628 |
1,521 |
$85K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
601 |
580 |
$29K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15,128 |
7,145 |
$25K |
| V2750 |
Anti-reflective coating, per lens |
1,134 |
505 |
$21K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
528 |
272 |
$19K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
229 |
217 |
$17K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
364 |
334 |
$13K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
102 |
102 |
$10K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
899 |
892 |
$9K |
| 92015 |
Determination of refractive state |
1,480 |
1,460 |
$7K |
| V2744 |
Tint, photochromatic, per lens |
76 |
40 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
42 |
17 |
$1K |
| V2781 |
Progressive lens, per lens |
24 |
12 |
$975.00 |
| V2299 |
Specialty bifocal (by report) |
24 |
12 |
$914.96 |
| 92310 |
|
13 |
13 |
$670.00 |
| 2024F |
|
244 |
243 |
$0.00 |
| 2022F |
|
37 |
37 |
$0.00 |
| 2023F |
|
95 |
94 |
$0.00 |