| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
750 |
747 |
$221K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,449 |
2,421 |
$133K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,838 |
1,822 |
$115K |
| V2020 |
Frames, purchases |
5,377 |
5,328 |
$57K |
| 92250 |
|
1,252 |
1,245 |
$56K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,677 |
2,300 |
$46K |
| 92015 |
Determination of refractive state |
3,131 |
3,119 |
$28K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,909 |
1,895 |
$26K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
869 |
518 |
$21K |
| 92341 |
|
458 |
458 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,203 |
1,037 |
$8K |
| 92020 |
|
474 |
471 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
113 |
111 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,810 |
952 |
$4K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
349 |
345 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
252 |
192 |
$3K |
| 92083 |
|
37 |
37 |
$2K |
| 92202 |
|
52 |
52 |
$1K |
| 92133 |
|
12 |
12 |
$334.05 |
| 76514 |
|
26 |
26 |
$209.90 |
| 2022F |
|
13 |
13 |
$0.00 |
| V2755 |
U-v lens, per lens |
30 |
15 |
$0.00 |
| 2023F |
|
42 |
42 |
$0.00 |