| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,221 |
2,217 |
$115K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,948 |
1,933 |
$85K |
| V2020 |
Frames, purchases |
6,759 |
6,723 |
$74K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,109 |
3,099 |
$41K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,036 |
2,321 |
$30K |
| 92015 |
Determination of refractive state |
2,370 |
2,370 |
$27K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
75 |
75 |
$22K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,937 |
2,154 |
$20K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,534 |
1,014 |
$17K |
| 92250 |
|
308 |
306 |
$12K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
831 |
539 |
$9K |
| 92341 |
|
469 |
469 |
$8K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
565 |
425 |
$7K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
261 |
256 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
171 |
112 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
48 |
48 |
$800.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
56 |
56 |
$720.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
96 |
65 |
$600.76 |