| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12,232 |
7,460 |
$327K |
| V2020 |
Frames, purchases |
12,307 |
12,206 |
$296K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,870 |
4,860 |
$228K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
2,266 |
1,490 |
$104K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,084 |
1,084 |
$64K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,134 |
1,131 |
$54K |
| 92002 |
|
1,016 |
1,015 |
$52K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,428 |
1,209 |
$50K |
| 92250 |
|
614 |
611 |
$29K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,486 |
2,485 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
7,221 |
4,088 |
$20K |
| 92015 |
Determination of refractive state |
2,154 |
2,153 |
$20K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
364 |
181 |
$10K |
| 92341 |
|
520 |
519 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
48 |
48 |
$3K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
94 |
94 |
$2K |
| 92370 |
|
464 |
463 |
$502.00 |
| 92134 |
|
12 |
12 |
$210.14 |
| 92371 |
|
17 |
17 |
$0.00 |