| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,854 |
1,819 |
$105K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,401 |
2,357 |
$104K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,399 |
2,350 |
$103K |
| V2020 |
Frames, purchases |
4,567 |
4,484 |
$79K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,587 |
3,521 |
$62K |
| 92015 |
Determination of refractive state |
2,594 |
2,524 |
$58K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
920 |
868 |
$44K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
2,029 |
1,980 |
$35K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
526 |
521 |
$34K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
763 |
745 |
$30K |
| 92250 |
|
631 |
621 |
$20K |
| 92341 |
|
757 |
746 |
$15K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
60 |
60 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
36 |
36 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$483.60 |
| 92083 |
|
12 |
12 |
$395.43 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$233.16 |
| 92133 |
|
12 |
12 |
$221.91 |