| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
2,982 |
2,954 |
$124K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,965 |
1,955 |
$109K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,341 |
1,326 |
$93K |
| V2020 |
Frames, purchases |
2,621 |
2,549 |
$44K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,190 |
1,198 |
$31K |
| 92285 |
|
1,139 |
1,125 |
$27K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
341 |
335 |
$13K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
280 |
143 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
246 |
137 |
$1K |
| 92083 |
|
24 |
24 |
$941.55 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
53 |
52 |
$586.78 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
74 |
43 |
$508.50 |
| 92015 |
Determination of refractive state |
44 |
44 |
$336.86 |
| 92133 |
|
12 |
12 |
$285.48 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
629 |
316 |
$66.00 |
| V2755 |
U-v lens, per lens |
740 |
362 |
$0.00 |
| G8397 |
Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy |
12 |
12 |
$0.00 |