| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,487 |
3,481 |
$74K |
| 92250 |
|
1,728 |
1,724 |
$61K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,431 |
1,430 |
$29K |
| V2020 |
Frames, purchases |
3,997 |
3,966 |
$23K |
| 92285 |
|
658 |
655 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,046 |
2,468 |
$14K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
748 |
741 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,985 |
1,416 |
$12K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
190 |
178 |
$7K |
| 92015 |
Determination of refractive state |
3,407 |
3,394 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,991 |
1,624 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
234 |
154 |
$776.95 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
24 |
13 |
$21.00 |
| V2750 |
Anti-reflective coating, per lens |
1,073 |
532 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
69 |
69 |
$0.00 |
| 2023F |
|
886 |
861 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
21 |
21 |
$0.00 |