| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,275 |
2,267 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
9,386 |
9,353 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
11,052 |
5,633 |
$2K |
| V2020 |
Frames, purchases |
11,947 |
11,560 |
$864.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,741 |
1,555 |
$816.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,126 |
615 |
$405.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13,315 |
6,686 |
$232.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,083 |
1,073 |
$22.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
3,057 |
1,530 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
397 |
204 |
$0.00 |
| V2781 |
Progressive lens, per lens |
26 |
13 |
$0.00 |
| 92002 |
|
208 |
208 |
$0.00 |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
27 |
27 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
124 |
66 |
$0.00 |
| V2599 |
Contact lens, other type |
38 |
38 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
127 |
127 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
24 |
12 |
$0.00 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
42 |
42 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
298 |
298 |
$0.00 |
| 92015 |
Determination of refractive state |
26 |
26 |
$0.00 |