| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,469 |
1,462 |
$52K |
| V2020 |
Frames, purchases |
3,088 |
3,037 |
$27K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,318 |
749 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,014 |
646 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
294 |
291 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
679 |
377 |
$3K |
| 92015 |
Determination of refractive state |
115 |
115 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
56 |
40 |
$627.22 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
30 |
17 |
$607.28 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
45 |
45 |
$560.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
25 |
25 |
$280.00 |
| V2755 |
U-v lens, per lens |
24 |
12 |
$0.00 |