| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,466 |
2,430 |
$159K |
| 92250 |
|
1,767 |
1,748 |
$78K |
| 92285 |
|
1,667 |
1,657 |
$48K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,013 |
1,178 |
$39K |
| V2020 |
Frames, purchases |
1,586 |
1,540 |
$18K |
| 92132 |
|
180 |
179 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
49 |
49 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
166 |
166 |
$2K |
| 92015 |
Determination of refractive state |
591 |
588 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
31 |
31 |
$880.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
292 |
202 |
$848.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
14 |
$615.24 |
| 76514 |
|
76 |
76 |
$551.31 |
| 92083 |
|
12 |
12 |
$465.00 |
| V2755 |
U-v lens, per lens |
690 |
331 |
$0.00 |