| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
5,730 |
5,678 |
$221K |
| V2020 |
Frames, purchases |
8,954 |
8,694 |
$111K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,114 |
2,900 |
$70K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,334 |
2,294 |
$60K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,105 |
840 |
$26K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
913 |
619 |
$24K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
7,941 |
4,930 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,661 |
1,594 |
$7K |
| 92341 |
|
534 |
523 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
162 |
101 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
80 |
79 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
69 |
69 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
16 |
12 |
$289.24 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
1,049 |
551 |
$276.40 |
| 92015 |
Determination of refractive state |
4,625 |
4,573 |
$0.00 |