| 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 |
5,923 |
3,455 |
$240K |
| V2020 |
Frames, purchases |
6,017 |
5,965 |
$176K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,537 |
2,491 |
$135K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,823 |
1,801 |
$119K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,659 |
2,344 |
$77K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,084 |
631 |
$62K |
| 92250 |
|
1,857 |
1,855 |
$34K |
| 92341 |
|
888 |
831 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
442 |
273 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
643 |
600 |
$9K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
176 |
174 |
$5K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
114 |
64 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
24 |
13 |
$960.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
12 |
$753.26 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
15 |
12 |
$714.10 |
| 92226 |
|
98 |
97 |
$593.50 |