| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,966 |
2,855 |
$123K |
| V2020 |
Frames, purchases |
5,639 |
5,400 |
$98K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,374 |
5,137 |
$90K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,234 |
1,204 |
$81K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
4,704 |
3,174 |
$59K |
| 92015 |
Determination of refractive state |
2,556 |
2,277 |
$57K |
| 92370 |
|
3,621 |
3,373 |
$33K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
776 |
749 |
$31K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
854 |
591 |
$23K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
340 |
320 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
316 |
210 |
$15K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
505 |
351 |
$14K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
185 |
177 |
$14K |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
255 |
155 |
$13K |
| V2781 |
Progressive lens, per lens |
203 |
98 |
$11K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
201 |
120 |
$8K |
| 92342 |
|
299 |
293 |
$6K |
| 92250 |
|
154 |
154 |
$5K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
40 |
38 |
$4K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
136 |
85 |
$3K |
| 92341 |
|
177 |
171 |
$3K |
| V2025 |
Deluxe frame |
60 |
24 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
62 |
26 |
$2K |
| 92133 |
|
91 |
87 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
14 |
$460.35 |
| 92083 |
|
13 |
13 |
$431.31 |
| 92202 |
|
47 |
44 |
$404.75 |
| V2756 |
Eye glass case |
15 |
15 |
$13.36 |