| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,099 |
2,098 |
$140K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,554 |
2,549 |
$32K |
| V2020 |
Frames, purchases |
2,934 |
2,929 |
$32K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
547 |
547 |
$24K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
1,417 |
1,403 |
$22K |
| 92015 |
Determination of refractive state |
1,921 |
1,921 |
$21K |
| 92250 |
|
468 |
468 |
$19K |
| 92225 |
|
572 |
571 |
$15K |
| 92202 |
|
768 |
767 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,226 |
1,216 |
$11K |
| 92060 |
|
198 |
198 |
$6K |
| 92285 |
|
415 |
415 |
$4K |
| 92341 |
|
232 |
231 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
262 |
262 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
38 |
$755.55 |
| 92083 |
|
13 |
13 |
$421.44 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
25 |
$216.00 |
| 99199 |
Unlisted special service, procedure or report |
16 |
16 |
$0.00 |