| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,063 |
4,003 |
$65K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,057 |
2,061 |
$59K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,148 |
566 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
599 |
597 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
735 |
735 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
353 |
353 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
634 |
322 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
248 |
130 |
$3K |
| 92002 |
|
43 |
43 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
41 |
41 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,016 |
1,006 |
$74.00 |
| V2755 |
U-v lens, per lens |
26 |
13 |
$0.00 |
| 92015 |
Determination of refractive state |
46 |
46 |
$0.00 |