| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
2,179 |
1,934 |
$39K |
| 92250 |
|
1,241 |
1,233 |
$36K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,672 |
3,652 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,611 |
5,581 |
$4K |
| 92133 |
|
123 |
121 |
$3K |
| 92083 |
|
142 |
142 |
$2K |
| 92015 |
Determination of refractive state |
6,354 |
6,273 |
$1K |
| V2020 |
Frames, purchases |
8,029 |
7,945 |
$928.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,792 |
1,292 |
$476.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
489 |
370 |
$393.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,552 |
3,640 |
$230.00 |
| 92020 |
|
14 |
14 |
$192.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
7,681 |
5,112 |
$150.80 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
671 |
496 |
$24.00 |
| V2750 |
Anti-reflective coating, per lens |
2,186 |
1,254 |
$0.00 |
| 2022F |
|
59 |
50 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
124 |
124 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
700 |
407 |
$0.00 |
| V2781 |
Progressive lens, per lens |
195 |
123 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
160 |
106 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
114 |
114 |
$0.00 |