| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
3,317 |
3,147 |
$129K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
4,729 |
4,433 |
$125K |
| V2020 |
Frames, purchases |
4,675 |
4,333 |
$123K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,825 |
1,711 |
$112K |
| 92015 |
Determination of refractive state |
2,680 |
2,589 |
$97K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,817 |
1,722 |
$87K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,308 |
3,135 |
$63K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,929 |
1,832 |
$53K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
720 |
686 |
$20K |
| 92341 |
|
956 |
900 |
$20K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
221 |
207 |
$10K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
162 |
147 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
108 |
107 |
$3K |
| V2118 |
Aniseikonic lens, single vision |
49 |
39 |
$1K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
24 |
22 |
$477.84 |
| 92310 |
|
31 |
24 |
$0.00 |