| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,159 |
3,092 |
$208K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,687 |
2,514 |
$152K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,642 |
2,590 |
$136K |
| V2020 |
Frames, purchases |
3,554 |
3,517 |
$101K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
904 |
874 |
$42K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
238 |
237 |
$21K |
| 92015 |
Determination of refractive state |
1,393 |
1,321 |
$15K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
319 |
314 |
$9K |
| V2025 |
Deluxe frame |
274 |
266 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
54 |
54 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
40 |
40 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
39 |
39 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
31 |
25 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
18 |
12 |
$559.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
284 |
282 |
$377.00 |
| V2760 |
Scratch resistant coating, per lens |
12 |
12 |
$124.00 |
| 99199 |
Unlisted special service, procedure or report |
104 |
103 |
$0.00 |
| 2024F |
|
180 |
174 |
$0.00 |
| 2026F |
|
14 |
13 |
$0.00 |