| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
846 |
843 |
$71K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,004 |
1,000 |
$58K |
| V2020 |
Frames, purchases |
1,954 |
1,949 |
$48K |
| 92015 |
Determination of refractive state |
1,957 |
1,946 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,133 |
1,129 |
$10K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
552 |
551 |
$10K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
302 |
302 |
$8K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
144 |
144 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
236 |
236 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
396 |
394 |
$3K |
| 92341 |
|
96 |
96 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
157 |
157 |
$2K |
| 92250 |
|
31 |
31 |
$442.59 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
27 |
27 |
$360.90 |