| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,820 |
3,596 |
$59K |
| 92250 |
|
1,484 |
1,384 |
$30K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
215 |
212 |
$5K |
| 92015 |
Determination of refractive state |
2,354 |
2,231 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
41 |
28 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
38 |
38 |
$706.67 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,662 |
823 |
$21.00 |
| V2020 |
Frames, purchases |
1,424 |
1,409 |
$20.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
56 |
28 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
153 |
77 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
13 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
60 |
30 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
100 |
50 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
31 |
31 |
$0.00 |