| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,866 |
4,806 |
$180K |
| V2020 |
Frames, purchases |
11,131 |
10,480 |
$157K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,199 |
5,768 |
$132K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,019 |
5,464 |
$60K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,280 |
1,260 |
$56K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,216 |
2,180 |
$48K |
| 92015 |
Determination of refractive state |
1,126 |
1,107 |
$22K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
350 |
350 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
572 |
515 |
$12K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
529 |
517 |
$10K |
| 92341 |
|
230 |
224 |
$6K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
409 |
403 |
$4K |
| V2299 |
Specialty bifocal (by report) |
131 |
128 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
57 |
57 |
$2K |
| V2301 |
Sphere, trifocal, plus or minus 4.12 to plus or minus 7.00d, per lens |
12 |
12 |
$367.20 |
| 92342 |
|
12 |
12 |
$360.22 |
| V2744 |
Tint, photochromatic, per lens |
111 |
107 |
$0.00 |
| V2781 |
Progressive lens, per lens |
131 |
128 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
202 |
198 |
$0.00 |