| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
6,574 |
5,349 |
$286K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
7,655 |
6,446 |
$222K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,479 |
2,614 |
$160K |
| 92015 |
Determination of refractive state |
7,117 |
5,994 |
$125K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,488 |
2,039 |
$110K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,374 |
1,155 |
$62K |
| V2025 |
Deluxe frame |
2,414 |
1,830 |
$43K |
| V2020 |
Frames, purchases |
1,590 |
1,443 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
626 |
599 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
109 |
103 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
73 |
71 |
$3K |
| 92341 |
|
15 |
12 |
$413.16 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
43 |
42 |
$304.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
96 |
94 |
$0.00 |
| 3072F |
|
40 |
40 |
$0.00 |