| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,010 |
4,886 |
$127K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,731 |
1,711 |
$78K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,246 |
2,177 |
$67K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,675 |
1,422 |
$64K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,904 |
2,856 |
$50K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,573 |
1,545 |
$24K |
| 92015 |
Determination of refractive state |
861 |
830 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
198 |
182 |
$12K |
| 92060 |
|
107 |
105 |
$6K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
59 |
58 |
$6K |
| V2025 |
Deluxe frame |
106 |
106 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,326 |
1,293 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
44 |
44 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
36 |
32 |
$924.00 |
| 92250 |
|
12 |
12 |
$893.28 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
47 |
46 |
$695.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
37 |
37 |
$520.00 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
17 |
17 |
$265.00 |