| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
6,165 |
5,923 |
$559K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
6,064 |
5,799 |
$449K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
11,861 |
11,023 |
$412K |
| V2020 |
Frames, purchases |
14,745 |
13,764 |
$405K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
10,637 |
9,974 |
$234K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
6,411 |
5,914 |
$185K |
| 92015 |
Determination of refractive state |
13,923 |
13,357 |
$157K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,391 |
1,325 |
$67K |
| 92370 |
|
3,385 |
3,232 |
$66K |
| 92341 |
|
170 |
158 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
100 |
91 |
$4K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
14 |
14 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
65 |
61 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
26 |
25 |
$990.35 |
| 92310 |
|
50 |
50 |
$0.00 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
28 |
26 |
$0.00 |