| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
796 |
787 |
$36K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
994 |
969 |
$27K |
| 92015 |
Determination of refractive state |
1,086 |
1,071 |
$20K |
| V2025 |
Deluxe frame |
471 |
448 |
$14K |
| V2020 |
Frames, purchases |
362 |
362 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
255 |
254 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
485 |
482 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
230 |
223 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
93 |
80 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
278 |
272 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
85 |
80 |
$2K |
| 92310 |
|
40 |
38 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
121 |
116 |
$2K |
| 92250 |
|
30 |
29 |
$952.34 |
| 92341 |
|
29 |
29 |
$816.06 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
25 |
25 |
$250.26 |
| 3072F |
|
28 |
27 |
$0.00 |