| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,719 |
1,254 |
$90K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,418 |
1,230 |
$62K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,285 |
1,102 |
$55K |
| V2025 |
Deluxe frame |
1,583 |
1,210 |
$31K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
929 |
890 |
$27K |
| 92015 |
Determination of refractive state |
1,249 |
1,189 |
$22K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
413 |
387 |
$19K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
116 |
81 |
$16K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
105 |
105 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
104 |
104 |
$5K |
| V2020 |
Frames, purchases |
146 |
96 |
$2K |
| 92341 |
|
57 |
56 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
33 |
24 |
$434.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
91 |
89 |
$132.50 |
| V2750 |
Anti-reflective coating, per lens |
108 |
43 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
66 |
49 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
16 |
16 |
$0.00 |
| S0581 |
Nonstandard lens (list this code in addition to the basic code for the lens) |
14 |
14 |
$0.00 |