| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
8,779 |
8,537 |
$125K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,765 |
4,264 |
$84K |
| 92002 |
|
1,571 |
1,544 |
$60K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,762 |
2,241 |
$45K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,946 |
2,712 |
$23K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
769 |
658 |
$17K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
323 |
319 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
749 |
749 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
742 |
742 |
$3K |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
102 |
98 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
116 |
116 |
$840.00 |
| 92250 |
|
12 |
12 |
$470.92 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
14 |
14 |
$80.00 |
| V2755 |
U-v lens, per lens |
1,878 |
939 |
$0.00 |
| 92341 |
|
13 |
12 |
$0.00 |