| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,996 |
3,972 |
$252K |
| V2020 |
Frames, purchases |
8,015 |
7,860 |
$174K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,207 |
4,187 |
$168K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,186 |
2,761 |
$75K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,478 |
3,418 |
$50K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,412 |
2,636 |
$40K |
| 92250 |
|
1,273 |
1,265 |
$33K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
427 |
422 |
$13K |
| 92341 |
|
623 |
604 |
$12K |
| V2219 |
Bifocal seg width over 28 mm |
141 |
139 |
$12K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
419 |
365 |
$8K |
| 92015 |
Determination of refractive state |
472 |
471 |
$6K |
| 92285 |
|
274 |
269 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,166 |
1,576 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
42 |
38 |
$971.94 |
| 76512 |
|
18 |
18 |
$669.20 |
| 76514 |
|
84 |
84 |
$480.85 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
14 |
14 |
$216.00 |
| 2022F |
|
13 |
13 |
$0.00 |
| 1036F |
|
916 |
914 |
$0.00 |