| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,161 |
5,121 |
$67K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,509 |
2,903 |
$54K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,317 |
2,308 |
$51K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,830 |
914 |
$10K |
| 92002 |
|
178 |
174 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
248 |
248 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
109 |
105 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
338 |
169 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
43 |
43 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
120 |
60 |
$944.84 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
979 |
523 |
$840.50 |
| 92250 |
|
12 |
12 |
$519.98 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
28 |
14 |
$123.24 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
154 |
78 |
$0.00 |