| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,474 |
6,352 |
$227K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,161 |
2,150 |
$197K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,442 |
4,015 |
$192K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,239 |
2,222 |
$154K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,793 |
1,652 |
$59K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,153 |
2,108 |
$31K |
| 92015 |
Determination of refractive state |
5,546 |
5,508 |
$27K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
570 |
317 |
$18K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
382 |
365 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
320 |
320 |
$10K |
| 92002 |
|
310 |
310 |
$10K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
212 |
196 |
$4K |
| V2300 |
Sphere, trifocal, plano to plus or minus 4.00d, per lens |
75 |
73 |
$2K |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
18 |
12 |
$1K |
| V2781 |
Progressive lens, per lens |
31 |
14 |
$997.88 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
15 |
13 |
$695.88 |