| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
988 |
968 |
$27K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
151 |
145 |
$10K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
444 |
442 |
$8K |
| 92015 |
Determination of refractive state |
699 |
693 |
$7K |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
359 |
208 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
40 |
40 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
63 |
62 |
$3K |
| 92250 |
|
36 |
36 |
$642.21 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
61 |
37 |
$315.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
12 |
$78.00 |
| V2760 |
Scratch resistant coating, per lens |
26 |
26 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$0.00 |