| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,328 |
3,320 |
$167K |
| V2020 |
Frames, purchases |
12,390 |
12,301 |
$68K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
8,833 |
5,044 |
$40K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
9,626 |
5,590 |
$29K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
431 |
429 |
$21K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,780 |
2,303 |
$20K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
299 |
299 |
$16K |
| 92015 |
Determination of refractive state |
3,951 |
3,936 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,924 |
1,726 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
232 |
232 |
$4K |
| 92250 |
|
112 |
111 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
455 |
230 |
$105.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
31 |
16 |
$21.00 |
| V2744 |
Tint, photochromatic, per lens |
254 |
126 |
$0.00 |
| V2599 |
Contact lens, other type |
75 |
75 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
28 |
14 |
$0.00 |
| V2781 |
Progressive lens, per lens |
99 |
51 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
24 |
12 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
24 |
12 |
$0.00 |
| V2500 |
Contact lens, pmma, spherical, per lens |
86 |
86 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
394 |
196 |
$0.00 |