| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,455 |
3,269 |
$102K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
2,536 |
2,501 |
$89K |
| V2020 |
Frames, purchases |
5,268 |
5,236 |
$52K |
| 92002 |
|
1,164 |
1,164 |
$38K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
660 |
655 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
300 |
297 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
808 |
455 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
293 |
293 |
$6K |
| 92250 |
|
55 |
55 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,035 |
2,513 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
40 |
40 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
59 |
30 |
$941.42 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
53 |
53 |
$698.50 |
| V2755 |
U-v lens, per lens |
870 |
434 |
$0.00 |