| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
2,339 |
2,273 |
$86K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,410 |
3,369 |
$58K |
| 92082 |
|
1,708 |
1,649 |
$25K |
| 76514 |
|
1,734 |
1,683 |
$25K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
537 |
523 |
$13K |
| 92020 |
|
766 |
755 |
$11K |
| 92133 |
|
393 |
375 |
$9K |
| 92285 |
|
267 |
255 |
$6K |
| 92083 |
|
313 |
307 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
138 |
132 |
$2K |
| 92015 |
Determination of refractive state |
575 |
531 |
$2K |
| 92341 |
|
121 |
121 |
$2K |
| 92002 |
|
288 |
287 |
$1K |
| 76512 |
|
62 |
41 |
$1K |
| 92286 |
|
143 |
125 |
$1K |
| 92134 |
|
286 |
278 |
$274.50 |
| 92202 |
|
76 |
70 |
$222.82 |
| V2020 |
Frames, purchases |
2,512 |
2,504 |
$200.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,910 |
1,960 |
$147.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
832 |
415 |
$52.00 |
| 68040 |
|
266 |
172 |
$1.00 |
| V2112 |
Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens |
124 |
62 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
310 |
154 |
$0.00 |
| S0500 |
Disposable contact lens, per lens |
17 |
17 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
50 |
25 |
$0.00 |
| V2500 |
Contact lens, pmma, spherical, per lens |
82 |
81 |
$0.00 |