| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,284 |
1,284 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
766 |
765 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
236 |
236 |
$5K |
| 92015 |
Determination of refractive state |
587 |
587 |
$5K |
| V2020 |
Frames, purchases |
2,247 |
2,229 |
$468.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,195 |
1,178 |
$325.85 |
| 92341 |
|
12 |
12 |
$300.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
705 |
375 |
$284.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,912 |
1,006 |
$140.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
56 |
29 |
$23.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
331 |
186 |
$21.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
149 |
149 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
65 |
65 |
$0.00 |