| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
745 |
636 |
$30K |
| 92015 |
Determination of refractive state |
1,855 |
1,831 |
$30K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
510 |
510 |
$28K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
503 |
397 |
$27K |
| V2020 |
Frames, purchases |
929 |
805 |
$24K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
761 |
737 |
$22K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
366 |
366 |
$19K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
53 |
53 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
81 |
81 |
$1K |
| 92002 |
|
14 |
12 |
$379.04 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$159.50 |
| V2755 |
U-v lens, per lens |
33 |
23 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
33 |
23 |
$0.00 |