| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
11,694 |
11,281 |
$485K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,824 |
5,621 |
$408K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,251 |
3,156 |
$312K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
10,628 |
6,199 |
$292K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,993 |
2,204 |
$97K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
9,106 |
8,814 |
$87K |
| 92015 |
Determination of refractive state |
10,201 |
9,856 |
$61K |
| 92250 |
|
999 |
982 |
$49K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
976 |
591 |
$27K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
117 |
116 |
$6K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
145 |
96 |
$5K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
33 |
28 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
39 |
30 |
$1K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
26 |
26 |
$957.76 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
22 |
12 |
$846.12 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
13 |
$530.92 |