| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,995 |
4,953 |
$223K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,359 |
5,281 |
$158K |
| 92015 |
Determination of refractive state |
7,678 |
7,592 |
$119K |
| V2020 |
Frames, purchases |
2,598 |
2,595 |
$103K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,299 |
2,270 |
$100K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,142 |
2,140 |
$28K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,736 |
1,734 |
$20K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
619 |
618 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
126 |
126 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
95 |
95 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
40 |
40 |
$596.94 |
| V2025 |
Deluxe frame |
16 |
16 |
$280.00 |