| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
10,080 |
7,528 |
$234K |
| V2020 |
Frames, purchases |
11,048 |
10,946 |
$220K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,581 |
2,573 |
$170K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,026 |
3,003 |
$138K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
2,503 |
1,790 |
$74K |
| 92002 |
|
587 |
586 |
$45K |
| 92015 |
Determination of refractive state |
5,341 |
5,324 |
$42K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
421 |
421 |
$35K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
950 |
501 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
8,753 |
4,759 |
$12K |
| 92230 |
|
162 |
161 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
147 |
147 |
$9K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
123 |
122 |
$9K |
| 92250 |
|
164 |
157 |
$6K |
| 92083 |
|
46 |
46 |
$2K |
| 92133 |
|
44 |
44 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
29 |
29 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
186 |
186 |
$897.15 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
17 |
17 |
$640.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$571.60 |
| 92225 |
|
36 |
18 |
$445.82 |
| 92202 |
|
13 |
13 |
$208.00 |
| 76514 |
|
13 |
13 |
$102.83 |