| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,419 |
2,417 |
$312K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,359 |
2,352 |
$265K |
| V2020 |
Frames, purchases |
6,080 |
6,051 |
$224K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,993 |
3,966 |
$112K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,792 |
3,056 |
$84K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,298 |
3,883 |
$60K |
| V2025 |
Deluxe frame |
648 |
645 |
$37K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
305 |
305 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
804 |
673 |
$18K |
| 92015 |
Determination of refractive state |
3,548 |
3,539 |
$17K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
562 |
495 |
$15K |
| 92341 |
|
148 |
148 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
124 |
124 |
$5K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
96 |
82 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28 |
28 |
$1K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
42 |
37 |
$787.63 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
13 |
$742.95 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
14 |
12 |
$136.22 |
| V2744 |
Tint, photochromatic, per lens |
81 |
81 |
$80.00 |
| V2750 |
Anti-reflective coating, per lens |
25 |
25 |
$0.00 |
| 2023F |
|
37 |
37 |
$0.00 |