| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
36,376 |
29,776 |
$939K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
42,126 |
15,006 |
$873K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
28,190 |
27,823 |
$698K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15,966 |
15,759 |
$439K |
| V2750 |
Anti-reflective coating, per lens |
18,133 |
7,596 |
$203K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
5,163 |
4,616 |
$191K |
| V2744 |
Tint, photochromatic, per lens |
8,745 |
4,320 |
$97K |
| V2299 |
Specialty bifocal (by report) |
5,439 |
2,660 |
$96K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
4,660 |
2,381 |
$94K |
| V2781 |
Progressive lens, per lens |
5,906 |
2,907 |
$81K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
44,358 |
16,307 |
$47K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,493 |
2,484 |
$43K |
| 92015 |
Determination of refractive state |
6,837 |
6,775 |
$29K |
| 92250 |
|
622 |
593 |
$25K |
| 92083 |
|
559 |
530 |
$19K |
| 92341 |
|
994 |
988 |
$17K |
| 92133 |
|
385 |
375 |
$10K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
140 |
140 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12,738 |
6,601 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
204 |
204 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,501 |
2,372 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
124 |
124 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
325 |
322 |
$1K |
| V2500 |
Contact lens, pmma, spherical, per lens |
25 |
25 |
$1K |
| 92310 |
|
14 |
14 |
$840.00 |
| 76514 |
|
64 |
61 |
$633.82 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
587 |
302 |
$557.94 |
| V2755 |
U-v lens, per lens |
215 |
213 |
$370.00 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
25 |
25 |
$200.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
130 |
124 |
$65.50 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
25 |
13 |
$0.00 |
| 3072F |
|
23 |
20 |
$0.00 |