| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,665 |
2,637 |
$117K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,265 |
2,229 |
$61K |
| 92015 |
Determination of refractive state |
3,898 |
3,852 |
$54K |
| V2020 |
Frames, purchases |
715 |
706 |
$28K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
467 |
463 |
$22K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
489 |
485 |
$21K |
| V2025 |
Deluxe frame |
604 |
590 |
$15K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
168 |
166 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
537 |
524 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
411 |
403 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
419 |
415 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
140 |
133 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$148.66 |