| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
5,655 |
5,630 |
$77K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,609 |
2,605 |
$58K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,738 |
1,733 |
$32K |
| 92015 |
Determination of refractive state |
1,355 |
1,353 |
$5K |
| V2020 |
Frames, purchases |
7,232 |
7,151 |
$840.00 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
14 |
14 |
$750.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,584 |
997 |
$415.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,280 |
2,042 |
$294.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
6,017 |
3,365 |
$231.00 |
| 92341 |
|
14 |
14 |
$200.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,229 |
2,793 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
21 |
12 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
154 |
99 |
$0.00 |
| 3072F |
|
1,184 |
1,177 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
43 |
43 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
82 |
82 |
$0.00 |