| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,557 |
2,551 |
$117K |
| 92250 |
|
1,603 |
1,598 |
$61K |
| 92083 |
|
1,413 |
1,407 |
$55K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,960 |
1,445 |
$49K |
| V2020 |
Frames, purchases |
2,542 |
2,514 |
$45K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
753 |
748 |
$45K |
| 92133 |
|
773 |
764 |
$19K |
| 92132 |
|
1,047 |
1,045 |
$19K |
| 92226 |
|
596 |
434 |
$8K |
| 92202 |
|
676 |
670 |
$7K |
| 92286 |
|
229 |
229 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
227 |
170 |
$4K |
| 92285 |
|
63 |
62 |
$4K |
| 83861 |
|
351 |
175 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
54 |
47 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
197 |
194 |
$2K |
| 92134 |
|
97 |
97 |
$2K |
| 92225 |
|
60 |
38 |
$905.02 |
| 92273 |
|
13 |
13 |
$356.64 |
| 76514 |
|
43 |
43 |
$302.33 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
504 |
285 |
$285.00 |
| 92145 |
|
39 |
39 |
$133.01 |
| 92015 |
Determination of refractive state |
12 |
12 |
$76.00 |
| 1036F |
|
25 |
24 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
13 |
12 |
$0.00 |
| 2022F |
|
14 |
14 |
$0.00 |