| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,427 |
3,358 |
$113K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,454 |
1,822 |
$103K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
547 |
544 |
$23K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,086 |
1,042 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
96 |
57 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
36 |
25 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
81 |
81 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$691.73 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
15 |
15 |
$612.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$600.00 |