| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,289 |
1,289 |
$64K |
| V2020 |
Frames, purchases |
1,428 |
1,388 |
$43K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
883 |
860 |
$39K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
427 |
426 |
$32K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,763 |
1,747 |
$28K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
988 |
927 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
357 |
352 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,409 |
1,110 |
$12K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
94 |
92 |
$8K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
105 |
96 |
$5K |
| 92015 |
Determination of refractive state |
360 |
343 |
$5K |
| V2781 |
Progressive lens, per lens |
56 |
29 |
$4K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
382 |
190 |
$3K |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
54 |
32 |
$3K |
| 92250 |
|
89 |
88 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
40 |
29 |
$801.10 |
| 92342 |
|
36 |
36 |
$760.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
720 |
687 |
$380.50 |
| 92370 |
|
27 |
26 |
$155.90 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$10.00 |
| V2750 |
Anti-reflective coating, per lens |
37 |
37 |
$0.00 |