| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,138 |
4,125 |
$118K |
| V2219 |
Bifocal seg width over 28 mm |
818 |
817 |
$66K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
954 |
952 |
$62K |
| 92250 |
|
1,685 |
1,682 |
$59K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,325 |
1,316 |
$57K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,421 |
1,304 |
$49K |
| 92083 |
|
1,559 |
1,554 |
$49K |
| 92341 |
|
1,988 |
1,978 |
$37K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,081 |
1,071 |
$23K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
80 |
79 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
140 |
136 |
$4K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
140 |
140 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
135 |
133 |
$1K |
| 92285 |
|
67 |
67 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
70 |
69 |
$1K |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
18 |
18 |
$436.32 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
109 |
105 |
$373.64 |
| V2755 |
U-v lens, per lens |
14 |
14 |
$349.78 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
625 |
312 |
$170.00 |
| 92015 |
Determination of refractive state |
15 |
15 |
$168.00 |
| 92226 |
|
14 |
14 |
$110.96 |
| 92020 |
|
13 |
13 |
$0.00 |