| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,420 |
1,412 |
$106K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,755 |
1,740 |
$105K |
| 92250 |
|
2,067 |
2,034 |
$94K |
| V2020 |
Frames, purchases |
4,217 |
4,159 |
$56K |
| 68761 |
|
489 |
305 |
$42K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,620 |
1,321 |
$40K |
| 92083 |
|
641 |
630 |
$31K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,398 |
1,382 |
$19K |
| 92015 |
Determination of refractive state |
1,383 |
1,363 |
$17K |
| 92285 |
|
700 |
698 |
$17K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
37 |
36 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
426 |
320 |
$10K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
578 |
571 |
$9K |
| 76512 |
|
53 |
27 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
561 |
373 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
199 |
100 |
$3K |
| 92202 |
|
142 |
138 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
61 |
57 |
$2K |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
104 |
104 |
$2K |
| 92060 |
|
26 |
26 |
$916.76 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
26 |
$171.48 |