| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,316 |
1,831 |
$134K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
978 |
951 |
$58K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
973 |
956 |
$47K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,364 |
1,084 |
$41K |
| V2020 |
Frames, purchases |
2,302 |
1,825 |
$18K |
| 92015 |
Determination of refractive state |
1,975 |
1,929 |
$12K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
253 |
190 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
219 |
174 |
$4K |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
101 |
80 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
106 |
98 |
$3K |
| 92134 |
|
74 |
74 |
$2K |
| V2202 |
Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00d, per lens |
13 |
12 |
$650.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
14 |
12 |
$394.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$360.00 |