| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14,930 |
14,559 |
$531K |
| V2020 |
Frames, purchases |
17,090 |
16,268 |
$366K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15,850 |
11,043 |
$334K |
| 92002 |
|
3,537 |
3,484 |
$133K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,169 |
2,147 |
$92K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,691 |
2,606 |
$89K |
| 92015 |
Determination of refractive state |
14,695 |
14,299 |
$72K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
22,464 |
14,735 |
$60K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
2,173 |
1,668 |
$39K |
| V2750 |
Anti-reflective coating, per lens |
3,702 |
2,971 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
218 |
218 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
203 |
195 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
80 |
80 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
98 |
66 |
$490.00 |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
101 |
83 |
$459.03 |
| V2756 |
Eye glass case |
204 |
195 |
$272.55 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
12 |
12 |
$0.00 |