| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
8,599 |
4,584 |
$144K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,250 |
3,248 |
$117K |
| V2020 |
Frames, purchases |
5,784 |
5,773 |
$64K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,270 |
1,270 |
$52K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
602 |
301 |
$5K |
| 92250 |
|
66 |
66 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,226 |
3,176 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
58 |
58 |
$2K |
| 92083 |
|
15 |
15 |
$604.50 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$507.00 |
| 76514 |
|
15 |
15 |
$119.85 |
| 92015 |
Determination of refractive state |
343 |
343 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
19 |
19 |
$0.00 |