| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,191 |
793 |
$76K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,248 |
853 |
$56K |
| V2020 |
Frames, purchases |
1,401 |
935 |
$23K |
| V2300 |
Sphere, trifocal, plano to plus or minus 4.00d, per lens |
45 |
13 |
$11K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
92 |
91 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
210 |
206 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
64 |
64 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
16 |
$640.00 |
| S0581 |
Nonstandard lens (list this code in addition to the basic code for the lens) |
13 |
13 |
$0.00 |