| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
15,311 |
15,134 |
$141K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,820 |
1,812 |
$102K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
5,308 |
5,253 |
$89K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,496 |
5,412 |
$84K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
3,989 |
3,952 |
$51K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,755 |
2,700 |
$45K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
992 |
980 |
$44K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,481 |
3,444 |
$44K |
| 92341 |
|
1,962 |
1,943 |
$37K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,007 |
1,966 |
$24K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,174 |
6,122 |
$23K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,270 |
1,250 |
$18K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
2,657 |
2,602 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
169 |
169 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,720 |
2,693 |
$1K |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
48 |
48 |
$1K |
| V2300 |
Sphere, trifocal, plano to plus or minus 4.00d, per lens |
852 |
849 |
$724.85 |
| V2744 |
Tint, photochromatic, per lens |
1,002 |
998 |
$549.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$137.87 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
25 |
25 |
$116.40 |
| V2220 |
Bifocal add over 3.25d |
25 |
25 |
$51.00 |
| V2755 |
U-v lens, per lens |
222 |
222 |
$0.00 |
| V2781 |
Progressive lens, per lens |
820 |
816 |
$0.00 |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
26 |
24 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
1,508 |
1,498 |
$0.00 |
| 92015 |
Determination of refractive state |
102 |
102 |
$0.00 |