| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
705 |
482 |
$32K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
638 |
474 |
$29K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
603 |
448 |
$27K |
| V2025 |
Deluxe frame |
551 |
415 |
$17K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
64 |
25 |
$13K |
| 92015 |
Determination of refractive state |
600 |
578 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
235 |
227 |
$6K |
| V2020 |
Frames, purchases |
104 |
71 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
48 |
48 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
16 |
16 |
$720.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
152 |
145 |
$607.95 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
36 |
36 |
$223.30 |
| S0581 |
Nonstandard lens (list this code in addition to the basic code for the lens) |
13 |
13 |
$0.00 |