| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,830 |
1,623 |
$129K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
462 |
442 |
$30K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
357 |
343 |
$26K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,040 |
1,010 |
$21K |
| V2020 |
Frames, purchases |
1,924 |
1,686 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
449 |
439 |
$6K |
| 92015 |
Determination of refractive state |
2,228 |
2,126 |
$6K |
| 92250 |
|
374 |
322 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,369 |
1,275 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
180 |
176 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$354.62 |
| 99072 |
|
60 |
57 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
34 |
34 |
$0.00 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
96 |
96 |
$0.00 |