| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,769 |
1,641 |
$103K |
| V2025 |
Deluxe frame |
998 |
786 |
$94K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,120 |
1,895 |
$63K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,054 |
1,012 |
$32K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
842 |
758 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
317 |
302 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
207 |
205 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
76 |
76 |
$3K |
| 92310 |
|
108 |
66 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
151 |
151 |
$2K |
| S0592 |
Comprehensive contact lens evaluation |
30 |
30 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
13 |
$438.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$385.00 |
| 92015 |
Determination of refractive state |
3,641 |
3,357 |
$14.85 |
| V2799 |
Vision item or service, miscellaneous |
1,273 |
825 |
$0.00 |