| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,222 |
964 |
$44K |
| V2020 |
Frames, purchases |
2,361 |
2,143 |
$26K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
287 |
287 |
$13K |
| 92002 |
|
390 |
390 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
280 |
139 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
80 |
80 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
51 |
51 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
30 |
13 |
$814.74 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$480.00 |
| 92015 |
Determination of refractive state |
1,330 |
1,325 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
74 |
74 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,018 |
448 |
$0.00 |