| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,616 |
1,586 |
$41K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
496 |
491 |
$27K |
| 92250 |
|
623 |
620 |
$24K |
| 92083 |
|
532 |
530 |
$19K |
| V2219 |
Bifocal seg width over 28 mm |
114 |
113 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
406 |
212 |
$8K |
| 92225 |
|
234 |
115 |
$2K |
| 92341 |
|
114 |
112 |
$2K |
| 92285 |
|
82 |
80 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
89 |
89 |
$2K |
| V2205 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
12 |
12 |
$384.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$148.50 |
| 92015 |
Determination of refractive state |
12 |
12 |
$144.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
345 |
173 |
$126.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
14 |
14 |
$45.60 |