| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
8,917 |
8,807 |
$252K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
7,547 |
7,440 |
$211K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,286 |
1,220 |
$149K |
| 0402T |
|
29 |
29 |
$97K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,170 |
3,548 |
$72K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
543 |
542 |
$68K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
9,715 |
5,553 |
$54K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,026 |
1,773 |
$51K |
| J2787 |
Riboflavin 5'-phosphate, ophthalmic solution, up to 3 ml |
27 |
27 |
$49K |
| V2025 |
Deluxe frame |
863 |
854 |
$40K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
2,431 |
1,721 |
$33K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
387 |
357 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
277 |
275 |
$30K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
521 |
493 |
$24K |
| 92341 |
|
539 |
536 |
$21K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
755 |
554 |
$16K |
| 92136 |
|
331 |
330 |
$15K |
| 92025 |
|
390 |
389 |
$13K |
| 92133 |
|
170 |
170 |
$7K |
| 92015 |
Determination of refractive state |
757 |
755 |
$4K |
| 92083 |
|
65 |
64 |
$4K |
| V2299 |
Specialty bifocal (by report) |
15 |
13 |
$1K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
102 |
79 |
$840.98 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
64 |
46 |
$426.11 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
27 |
24 |
$249.31 |
| V2744 |
Tint, photochromatic, per lens |
24 |
24 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
167 |
164 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
12 |
12 |
$0.00 |