| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
782 |
775 |
$54K |
| V2020 |
Frames, purchases |
1,407 |
1,391 |
$43K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
766 |
752 |
$40K |
| 92083 |
|
1,303 |
1,280 |
$36K |
| 92250 |
|
908 |
890 |
$20K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
890 |
881 |
$17K |
| 92015 |
Determination of refractive state |
1,398 |
1,374 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
780 |
772 |
$9K |
| 92285 |
|
969 |
859 |
$9K |
| 92341 |
|
360 |
358 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
349 |
342 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
87 |
87 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
89 |
87 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
111 |
108 |
$985.48 |
| 92342 |
|
12 |
12 |
$245.60 |
| V2756 |
Eye glass case |
1,068 |
1,055 |
$169.56 |
| 2022F |
|
240 |
236 |
$0.13 |
| 2027F |
|
164 |
162 |
$0.00 |
| 2019F |
|
95 |
95 |
$0.00 |
| 1036F |
|
105 |
102 |
$0.00 |
| 4177F |
|
125 |
121 |
$0.00 |