| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
22,984 |
22,639 |
$379K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14,911 |
13,149 |
$255K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
8,023 |
7,631 |
$146K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
3,439 |
3,073 |
$50K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
843 |
792 |
$29K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
493 |
492 |
$21K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
1,259 |
1,160 |
$18K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
341 |
341 |
$15K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
520 |
441 |
$14K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
592 |
541 |
$8K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
163 |
163 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
25 |
25 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
25 |
17 |
$757.24 |
| V2109 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens |
30 |
24 |
$752.99 |
| V2025 |
Deluxe frame |
16 |
15 |
$610.34 |