| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,939 |
6,916 |
$20K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,100 |
3,092 |
$20K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
365 |
364 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
5,019 |
4,795 |
$13K |
| 92002 |
|
241 |
241 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,873 |
3,863 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,586 |
3,173 |
$10K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,034 |
990 |
$8K |
| 92015 |
Determination of refractive state |
4,554 |
4,528 |
$6K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
25 |
25 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
591 |
591 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
551 |
300 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
58 |
57 |
$0.00 |
| 3072F |
|
231 |
231 |
$0.00 |
| V2599 |
Contact lens, other type |
26 |
26 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
88 |
88 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
75 |
75 |
$0.00 |
| V2500 |
Contact lens, pmma, spherical, per lens |
14 |
14 |
$0.00 |