| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
8,659 |
4,301 |
$191K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,495 |
1,478 |
$122K |
| V2020 |
Frames, purchases |
9,881 |
9,551 |
$121K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,989 |
1,838 |
$105K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,087 |
2,073 |
$97K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,970 |
1,947 |
$83K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,990 |
1,940 |
$81K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
2,037 |
1,025 |
$61K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
725 |
355 |
$20K |
| 92341 |
|
345 |
343 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
18,445 |
8,913 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
361 |
351 |
$5K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
40 |
40 |
$592.60 |
| 92133 |
|
17 |
17 |
$502.45 |
| 92015 |
Determination of refractive state |
26 |
26 |
$213.74 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
2,599 |
1,252 |
$3.84 |
| 2022F |
|
145 |
144 |
$0.00 |