| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,599 |
2,596 |
$191K |
| 92250 |
|
2,044 |
2,035 |
$95K |
| 92083 |
|
1,841 |
1,828 |
$90K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,364 |
1,878 |
$55K |
| 92285 |
|
2,059 |
2,045 |
$54K |
| V2020 |
Frames, purchases |
3,179 |
3,152 |
$39K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
461 |
461 |
$27K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
107 |
107 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
60 |
58 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
122 |
122 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
332 |
190 |
$1K |
| 92015 |
Determination of refractive state |
47 |
47 |
$757.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
172 |
99 |
$634.64 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
13 |
$342.96 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
13 |
13 |
$90.00 |
| V2755 |
U-v lens, per lens |
194 |
97 |
$0.00 |