| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
6,102 |
6,034 |
$281K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
8,059 |
4,437 |
$112K |
| V2020 |
Frames, purchases |
8,539 |
8,390 |
$97K |
| 92250 |
|
2,056 |
2,032 |
$90K |
| 92285 |
|
1,794 |
1,782 |
$46K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,446 |
769 |
$30K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,768 |
3,484 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
827 |
820 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,445 |
819 |
$7K |
| 92002 |
|
157 |
157 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
79 |
79 |
$4K |
| 76512 |
|
112 |
59 |
$3K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
357 |
357 |
$2K |
| 92015 |
Determination of refractive state |
206 |
205 |
$2K |
| 92341 |
|
25 |
24 |
$362.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
25 |
$228.64 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
12 |
12 |
$148.50 |
| V2111 |
Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens |
13 |
13 |
$128.70 |
| V2755 |
U-v lens, per lens |
1,394 |
697 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
19 |
19 |
$0.00 |