| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,623 |
1,536 |
$106K |
| V2020 |
Frames, purchases |
2,202 |
2,094 |
$88K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,476 |
771 |
$31K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
324 |
293 |
$27K |
| 92015 |
Determination of refractive state |
2,582 |
2,433 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
126 |
123 |
$5K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
406 |
393 |
$3K |
| V2755 |
U-v lens, per lens |
699 |
657 |
$1K |
| 92082 |
|
30 |
26 |
$853.61 |
| 92250 |
|
14 |
14 |
$577.97 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
14 |
$554.18 |