| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,979 |
3,759 |
$159K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,556 |
2,431 |
$77K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,507 |
2,390 |
$77K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
415 |
343 |
$25K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,597 |
3,421 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,638 |
2,413 |
$14K |
| 92015 |
Determination of refractive state |
3,783 |
3,642 |
$11K |
| 92250 |
|
213 |
208 |
$7K |
| 92341 |
|
258 |
238 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,544 |
1,494 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
218 |
197 |
$2K |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
21 |
21 |
$2K |
| V2755 |
U-v lens, per lens |
1,270 |
1,214 |
$478.72 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
12 |
$42.00 |
| V2756 |
Eye glass case |
127 |
127 |
$0.00 |
| 92342 |
|
127 |
127 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
16 |
16 |
$0.00 |
| 3072F |
|
13 |
13 |
$0.00 |
| G0117 |
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
286 |
286 |
$0.00 |
| V2025 |
Deluxe frame |
145 |
125 |
$0.00 |
| 2022F |
|
288 |
286 |
$0.00 |