| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,847 |
3,688 |
$123K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,712 |
2,699 |
$103K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,427 |
2,412 |
$89K |
| V2020 |
Frames, purchases |
5,235 |
5,181 |
$61K |
| 92250 |
|
1,187 |
1,164 |
$49K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
257 |
255 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
802 |
410 |
$10K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
256 |
252 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
49 |
49 |
$3K |
| 92015 |
Determination of refractive state |
424 |
423 |
$988.00 |
| 92002 |
|
24 |
24 |
$740.16 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$448.92 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,410 |
1,720 |
$376.00 |
| V2755 |
U-v lens, per lens |
340 |
170 |
$0.00 |