| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
5,228 |
5,181 |
$237K |
| 92015 |
Determination of refractive state |
2,775 |
2,770 |
$113K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,910 |
1,904 |
$95K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,474 |
2,685 |
$86K |
| V2020 |
Frames, purchases |
3,772 |
3,753 |
$48K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,230 |
2,229 |
$33K |
| 92002 |
|
199 |
199 |
$6K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
156 |
82 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
36 |
36 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
42 |
42 |
$930.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
28 |
15 |
$818.48 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
117 |
61 |
$784.44 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
81 |
80 |
$761.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
394 |
236 |
$573.00 |
| 3072F |
|
175 |
175 |
$0.00 |
| V2755 |
U-v lens, per lens |
170 |
85 |
$0.00 |