| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,634 |
930 |
$26K |
| V2020 |
Frames, purchases |
1,500 |
1,485 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
752 |
751 |
$15K |
| 92250 |
|
187 |
184 |
$8K |
| 92002 |
|
217 |
217 |
$8K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
102 |
102 |
$6K |
| 92015 |
Determination of refractive state |
119 |
119 |
$5K |
| 92285 |
|
153 |
151 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
75 |
75 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
324 |
162 |
$1K |
| 92083 |
|
25 |
25 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,164 |
615 |
$904.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
16 |
16 |
$280.00 |
| V2755 |
U-v lens, per lens |
488 |
244 |
$0.00 |