| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,809 |
4,729 |
$431K |
| V2025 |
Deluxe frame |
2,979 |
2,666 |
$205K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,084 |
1,899 |
$189K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,955 |
2,649 |
$182K |
| V2219 |
Bifocal seg width over 28 mm |
2,134 |
1,924 |
$168K |
| V2760 |
Scratch resistant coating, per lens |
2,991 |
2,671 |
$82K |
| 92342 |
|
1,859 |
1,677 |
$68K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,198 |
3,161 |
$53K |
| 92250 |
|
1,061 |
1,025 |
$49K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
748 |
676 |
$43K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
305 |
295 |
$42K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
383 |
364 |
$40K |
| 92015 |
Determination of refractive state |
2,276 |
2,169 |
$37K |
| 92341 |
|
1,246 |
1,146 |
$37K |
| 92060 |
|
657 |
612 |
$34K |
| V2750 |
Anti-reflective coating, per lens |
800 |
706 |
$22K |
| 99205 |
Prolong outpt/office vis |
18 |
14 |
$2K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
13 |
13 |
$1K |
| 92134 |
|
14 |
12 |
$396.72 |