| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,817 |
2,800 |
$201K |
| 92250 |
|
1,908 |
1,899 |
$88K |
| 92083 |
|
1,409 |
1,396 |
$69K |
| V2020 |
Frames, purchases |
5,290 |
5,251 |
$62K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,749 |
2,175 |
$60K |
| 92285 |
|
1,564 |
1,548 |
$39K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
454 |
452 |
$24K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
955 |
951 |
$13K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
405 |
239 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,153 |
779 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
71 |
70 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,761 |
915 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
329 |
204 |
$3K |
| 92082 |
|
64 |
64 |
$3K |
| 92225 |
|
111 |
69 |
$2K |
| 92015 |
Determination of refractive state |
145 |
145 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
116 |
112 |
$1K |
| 92341 |
|
60 |
60 |
$1K |
| V2219 |
Bifocal seg width over 28 mm |
12 |
12 |
$880.00 |