| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
10,269 |
7,899 |
$462K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
7,434 |
5,793 |
$321K |
| 92015 |
Determination of refractive state |
16,538 |
12,069 |
$209K |
| V2020 |
Frames, purchases |
2,358 |
2,355 |
$94K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,924 |
1,921 |
$39K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,823 |
1,820 |
$23K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,068 |
1,067 |
$11K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
219 |
216 |
$10K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
190 |
189 |
$9K |
| 92341 |
|
285 |
285 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
516 |
516 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
83 |
83 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
115 |
115 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
14 |
$273.46 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$255.20 |
| 3072F |
|
133 |
133 |
$0.00 |