| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,289 |
2,262 |
$136K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,026 |
1,589 |
$51K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
958 |
940 |
$46K |
| V2020 |
Frames, purchases |
2,515 |
2,481 |
$30K |
| 92015 |
Determination of refractive state |
646 |
640 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
331 |
323 |
$4K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
132 |
129 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
47 |
46 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
94 |
51 |
$1K |
| 92202 |
|
103 |
100 |
$1K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
67 |
66 |
$904.50 |
| 92341 |
|
50 |
49 |
$900.00 |
| 92134 |
|
16 |
15 |
$480.32 |
| 92250 |
|
14 |
14 |
$429.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
13 |
$164.32 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
526 |
255 |
$0.00 |