| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
10,787 |
6,515 |
$520K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,505 |
5,390 |
$245K |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
5,371 |
3,133 |
$179K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,072 |
2,033 |
$110K |
| V2020 |
Frames, purchases |
10,146 |
6,893 |
$92K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,252 |
1,150 |
$60K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,165 |
787 |
$37K |
| 92015 |
Determination of refractive state |
6,720 |
6,580 |
$36K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28 |
24 |
$918.75 |
| V2202 |
Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00d, per lens |
20 |
12 |
$850.00 |
| V2750 |
Anti-reflective coating, per lens |
111 |
68 |
$160.00 |
| V2744 |
Tint, photochromatic, per lens |
16 |
14 |
$0.00 |