| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
216 |
216 |
$18K |
| V2020 |
Frames, purchases |
1,256 |
1,246 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
815 |
810 |
$10K |
| 92250 |
|
215 |
213 |
$9K |
| 92015 |
Determination of refractive state |
474 |
470 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
477 |
473 |
$4K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
67 |
67 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
35 |
33 |
$3K |
| 92285 |
|
230 |
230 |
$2K |
| V2219 |
Bifocal seg width over 28 mm |
46 |
45 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
235 |
233 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$779.68 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
34 |
33 |
$627.60 |
| 92341 |
|
48 |
47 |
$581.25 |