| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,173 |
3,148 |
$215K |
| 92250 |
|
2,984 |
2,974 |
$125K |
| V2020 |
Frames, purchases |
6,147 |
6,108 |
$87K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,216 |
1,757 |
$63K |
| 92083 |
|
1,262 |
1,261 |
$61K |
| 92285 |
|
2,260 |
2,243 |
$50K |
| 92002 |
|
1,465 |
1,461 |
$43K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
558 |
558 |
$43K |
| 76512 |
|
743 |
375 |
$42K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,672 |
2,004 |
$41K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,872 |
2,866 |
$41K |
| 92060 |
|
786 |
786 |
$37K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,219 |
2,580 |
$22K |
| 92015 |
Determination of refractive state |
742 |
742 |
$13K |
| 92341 |
|
651 |
650 |
$13K |
| 92286 |
|
434 |
433 |
$11K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
366 |
188 |
$11K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
281 |
204 |
$7K |
| 92082 |
|
148 |
147 |
$5K |
| 76514 |
|
489 |
487 |
$4K |
| 92025 |
|
142 |
141 |
$3K |
| 92225 |
|
96 |
96 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
42 |
28 |
$742.12 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$520.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
14 |
14 |
$420.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
20 |
12 |
$382.92 |
| 92202 |
|
17 |
17 |
$175.27 |
| 92020 |
|
55 |
55 |
$104.83 |
| 92133 |
|
13 |
13 |
$0.00 |