| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
6,541 |
6,408 |
$292K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,963 |
3,904 |
$250K |
| 92083 |
|
4,495 |
4,431 |
$190K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,898 |
2,833 |
$144K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,889 |
2,808 |
$79K |
| V2020 |
Frames, purchases |
4,415 |
4,084 |
$78K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,194 |
1,086 |
$44K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,537 |
882 |
$33K |
| 92225 |
|
1,190 |
629 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,918 |
1,063 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
299 |
172 |
$2K |
| 92226 |
|
46 |
29 |
$780.25 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
70 |
41 |
$675.46 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$375.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$330.00 |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
70 |
69 |
$39.00 |
| 92015 |
Determination of refractive state |
14 |
14 |
$0.00 |
| V2755 |
U-v lens, per lens |
150 |
75 |
$0.00 |