| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,323 |
3,318 |
$107K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,660 |
2,658 |
$100K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,148 |
3,616 |
$91K |
| V2020 |
Frames, purchases |
7,410 |
7,340 |
$90K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,159 |
2,130 |
$29K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,004 |
546 |
$20K |
| 92015 |
Determination of refractive state |
1,247 |
1,244 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,121 |
2,326 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,002 |
1,529 |
$14K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
309 |
277 |
$11K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
310 |
309 |
$5K |
| 92341 |
|
225 |
220 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
315 |
200 |
$4K |
| 92083 |
|
14 |
12 |
$465.00 |
| V2755 |
U-v lens, per lens |
374 |
187 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
26 |
13 |
$0.00 |