| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,003 |
753 |
$96K |
| V2020 |
Frames, purchases |
1,225 |
1,094 |
$78K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,762 |
1,689 |
$53K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
812 |
780 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
810 |
723 |
$21K |
| 92310 |
|
67 |
56 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
46 |
46 |
$2K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
12 |
12 |
$692.99 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
30 |
$646.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
16 |
$560.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
12 |
$325.00 |
| 92015 |
Determination of refractive state |
2,906 |
2,782 |
$210.95 |
| V2799 |
Vision item or service, miscellaneous |
1,316 |
845 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
12 |
12 |
$0.00 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
361 |
281 |
$0.00 |