| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,363 |
3,207 |
$152K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,124 |
3,004 |
$139K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,111 |
1,804 |
$124K |
| V2025 |
Deluxe frame |
4,393 |
4,006 |
$112K |
| 92015 |
Determination of refractive state |
5,490 |
5,330 |
$90K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,880 |
2,771 |
$83K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,655 |
1,381 |
$74K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,428 |
1,393 |
$25K |
| 92310 |
|
391 |
376 |
$22K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
456 |
446 |
$20K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
175 |
154 |
$19K |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
177 |
168 |
$15K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
314 |
308 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,555 |
1,517 |
$9K |
| V2020 |
Frames, purchases |
711 |
657 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
167 |
166 |
$3K |
| V2599 |
Contact lens, other type |
26 |
26 |
$3K |
| 92250 |
|
40 |
40 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$788.40 |