| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,602 |
4,441 |
$135K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,889 |
3,400 |
$90K |
| V2020 |
Frames, purchases |
7,267 |
7,056 |
$80K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,222 |
597 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
958 |
477 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
53 |
53 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
66 |
66 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
16 |
16 |
$638.00 |
| 92250 |
|
14 |
13 |
$546.50 |
| V2205 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
14 |
14 |
$448.00 |
| 92341 |
|
17 |
17 |
$340.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,068 |
1,012 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
13 |
$0.00 |