| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,073 |
1,054 |
$38K |
| V2020 |
Frames, purchases |
1,312 |
1,306 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
679 |
523 |
$8K |
| 92250 |
|
76 |
76 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
461 |
300 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
202 |
199 |
$3K |
| 92015 |
Determination of refractive state |
160 |
159 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
114 |
86 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
55 |
40 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
19 |
19 |
$440.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
16 |
13 |
$314.04 |
| 92341 |
|
12 |
12 |
$224.00 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
25 |
25 |
$198.00 |