| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,547 |
3,490 |
$196K |
| 92250 |
|
3,636 |
3,611 |
$159K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
477 |
466 |
$129K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,737 |
1,705 |
$109K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,090 |
3,669 |
$96K |
| V2020 |
Frames, purchases |
6,976 |
6,928 |
$83K |
| 92081 |
|
1,437 |
1,424 |
$47K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,439 |
2,411 |
$32K |
| 92015 |
Determination of refractive state |
2,667 |
2,658 |
$29K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,091 |
576 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,954 |
1,770 |
$15K |
| 92310 |
|
65 |
64 |
$9K |
| 76514 |
|
1,019 |
1,009 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,752 |
929 |
$7K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
519 |
516 |
$7K |
| 92083 |
|
130 |
130 |
$6K |
| 92286 |
|
69 |
69 |
$6K |
| 92341 |
|
311 |
307 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
119 |
118 |
$5K |
| 92082 |
|
102 |
102 |
$4K |
| 92145 |
|
397 |
396 |
$4K |
| 92285 |
|
48 |
48 |
$1K |
| 92020 |
|
68 |
68 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
97 |
64 |
$1K |
| 92133 |
|
24 |
24 |
$674.58 |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
17 |
17 |
$247.50 |
| 92202 |
|
12 |
12 |
$158.10 |
| V2755 |
U-v lens, per lens |
2,974 |
1,479 |
$0.00 |