| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,540 |
1,503 |
$98K |
| 92250 |
|
934 |
917 |
$40K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
831 |
806 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
711 |
697 |
$26K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
431 |
429 |
$22K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
375 |
371 |
$11K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
366 |
355 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
258 |
237 |
$7K |
| 92083 |
|
117 |
116 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
113 |
104 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
41 |
41 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
35 |
35 |
$1K |
| 92310 |
|
32 |
31 |
$973.42 |
| 92015 |
Determination of refractive state |
125 |
124 |
$853.90 |
| 92133 |
|
28 |
28 |
$644.04 |
| V2025 |
Deluxe frame |
15 |
15 |
$332.44 |
| V2750 |
Anti-reflective coating, per lens |
16 |
12 |
$287.56 |