| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
13,616 |
13,496 |
$169K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
11,862 |
6,549 |
$168K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,089 |
3,083 |
$111K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,210 |
4,204 |
$110K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
3,886 |
2,154 |
$72K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,613 |
2,022 |
$22K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
747 |
746 |
$10K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,274 |
683 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12,531 |
6,436 |
$8K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
96 |
96 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
53 |
53 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
68 |
68 |
$1K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
17 |
17 |
$288.00 |
| V2755 |
U-v lens, per lens |
5,998 |
2,987 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
24 |
12 |
$0.00 |
| V2025 |
Deluxe frame |
50 |
50 |
$0.00 |