| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,759 |
6,538 |
$313K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,241 |
4,104 |
$218K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,698 |
2,636 |
$122K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
6,504 |
6,286 |
$21K |
| 92015 |
Determination of refractive state |
6,998 |
6,790 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,825 |
3,946 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,345 |
956 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
124 |
111 |
$636.18 |
| 3072F |
|
655 |
652 |
$234.36 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
12 |
12 |
$230.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
289 |
169 |
$52.32 |
| 92341 |
|
293 |
290 |
$30.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$24.36 |
| 92342 |
|
1,618 |
1,598 |
$0.00 |
| V2756 |
Eye glass case |
1,616 |
1,597 |
$0.00 |
| V2755 |
U-v lens, per lens |
70 |
70 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
12 |
$0.00 |
| 2022F |
|
1,243 |
1,241 |
$0.00 |
| G0117 |
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
1,475 |
1,475 |
$0.00 |