| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
496 |
486 |
$20K |
| V2020 |
Frames, purchases |
708 |
677 |
$20K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
100 |
97 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
51 |
49 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
105 |
101 |
$4K |
| 92015 |
Determination of refractive state |
549 |
517 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
128 |
127 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$600.12 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
29 |
28 |
$0.00 |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
24 |
24 |
$0.00 |