| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
5,305 |
2,656 |
$78K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,561 |
2,558 |
$65K |
| V2020 |
Frames, purchases |
3,837 |
3,799 |
$46K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,504 |
753 |
$31K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
875 |
453 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,523 |
2,274 |
$3K |
| 92002 |
|
92 |
92 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
71 |
71 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
195 |
102 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$280.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$162.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$160.00 |
| 92015 |
Determination of refractive state |
690 |
689 |
$0.00 |
| V2755 |
U-v lens, per lens |
1,454 |
721 |
$0.00 |