| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
8,975 |
4,368 |
$152K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,133 |
3,103 |
$137K |
| V2020 |
Frames, purchases |
8,302 |
8,074 |
$85K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,776 |
877 |
$41K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,335 |
1,331 |
$36K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
56 |
55 |
$16K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
937 |
917 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,264 |
720 |
$10K |
| V2219 |
Bifocal seg width over 28 mm |
65 |
61 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
210 |
136 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
47 |
47 |
$3K |
| 92341 |
|
134 |
127 |
$3K |
| 92250 |
|
12 |
12 |
$489.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
7,146 |
3,480 |
$220.00 |
| V2755 |
U-v lens, per lens |
254 |
127 |
$0.00 |
| 3072F |
|
12 |
12 |
$0.00 |
| 92015 |
Determination of refractive state |
846 |
845 |
$0.00 |