| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2219 |
Bifocal seg width over 28 mm |
2,291 |
2,282 |
$199K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,566 |
2,483 |
$57K |
| 92341 |
|
2,537 |
2,527 |
$50K |
| V2220 |
Bifocal add over 3.25d |
2,421 |
2,407 |
$38K |
| V2020 |
Frames, purchases |
3,527 |
3,486 |
$36K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,147 |
981 |
$34K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
388 |
388 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
513 |
477 |
$7K |
| 92015 |
Determination of refractive state |
1,578 |
1,332 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
104 |
52 |
$2K |
| 92002 |
|
12 |
12 |
$458.48 |
| 92060 |
|
424 |
419 |
$365.68 |
| 92083 |
|
369 |
365 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
119 |
119 |
$0.00 |
| 2022F |
|
670 |
571 |
$0.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
473 |
469 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,037 |
511 |
$0.00 |
| 92082 |
|
100 |
98 |
$0.00 |
| V2741 |
|
360 |
358 |
$0.00 |