| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
7,369 |
4,922 |
$318K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
6,722 |
2,265 |
$185K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
4,184 |
4,128 |
$179K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
5,297 |
1,842 |
$146K |
| 92002 |
|
2,208 |
2,147 |
$92K |
| 92250 |
|
272 |
270 |
$14K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
347 |
198 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
243 |
243 |
$11K |
| V2744 |
Tint, photochromatic, per lens |
306 |
143 |
$10K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
126 |
64 |
$5K |
| V2299 |
Specialty bifocal (by report) |
100 |
50 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
359 |
340 |
$4K |
| V2781 |
Progressive lens, per lens |
100 |
50 |
$3K |
| V2750 |
Anti-reflective coating, per lens |
90 |
40 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
8,711 |
2,379 |
$2K |
| 92015 |
Determination of refractive state |
272 |
257 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
30 |
28 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
13 |
13 |
$390.00 |
| 2022F |
|
159 |
157 |
$0.00 |