| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,723 |
3,713 |
$139K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
8,467 |
4,526 |
$120K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,759 |
3,737 |
$114K |
| V2020 |
Frames, purchases |
8,879 |
8,783 |
$108K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,686 |
891 |
$36K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,832 |
1,812 |
$24K |
| 92015 |
Determination of refractive state |
2,027 |
2,003 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,675 |
1,834 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,657 |
3,482 |
$17K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
720 |
456 |
$8K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
366 |
362 |
$6K |
| 92341 |
|
291 |
288 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
194 |
117 |
$825.64 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$440.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
12 |
$425.52 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
68 |
41 |
$363.80 |
| V2755 |
U-v lens, per lens |
840 |
415 |
$0.00 |