| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,268 |
1,262 |
$70K |
| 76512 |
|
624 |
311 |
$43K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,991 |
1,164 |
$34K |
| 92250 |
|
653 |
651 |
$28K |
| V2020 |
Frames, purchases |
2,015 |
2,009 |
$23K |
| 92285 |
|
755 |
752 |
$19K |
| 68801 |
|
207 |
104 |
$8K |
| 92082 |
|
103 |
103 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
236 |
235 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
74 |
73 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
93 |
63 |
$937.95 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
28 |
28 |
$504.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
600 |
302 |
$24.00 |
| 92286 |
|
57 |
57 |
$0.00 |
| 68040 |
|
115 |
114 |
$0.00 |
| 92025 |
|
55 |
55 |
$0.00 |