| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,568 |
3,554 |
$232K |
| 92002 |
|
3,208 |
3,197 |
$135K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,382 |
3,372 |
$72K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
779 |
779 |
$45K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
464 |
464 |
$34K |
| 92083 |
|
531 |
529 |
$30K |
| 92250 |
|
511 |
510 |
$27K |
| 68761 |
|
260 |
130 |
$19K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
377 |
371 |
$16K |
| 76512 |
|
252 |
126 |
$14K |
| 92286 |
|
112 |
112 |
$11K |
| 92285 |
|
73 |
73 |
$4K |
| V2781 |
Progressive lens, per lens |
60 |
60 |
$3K |
| 92020 |
|
139 |
139 |
$2K |
| V2299 |
Specialty bifocal (by report) |
60 |
60 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
31 |
31 |
$1K |
| 92202 |
|
62 |
62 |
$642.62 |
| 92060 |
|
15 |
15 |
$623.85 |
| V2750 |
Anti-reflective coating, per lens |
96 |
96 |
$558.00 |
| 92133 |
|
15 |
15 |
$512.85 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15 |
12 |
$459.45 |
| 92015 |
Determination of refractive state |
28 |
28 |
$366.00 |
| 76514 |
|
32 |
32 |
$281.60 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
46 |
46 |
$166.00 |
| V2744 |
Tint, photochromatic, per lens |
18 |
18 |
$0.00 |
| 2022F |
|
865 |
860 |
$0.00 |
| 68040 |
|
304 |
150 |
$0.00 |
| 92025 |
|
16 |
16 |
$0.00 |