| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,373 |
2,364 |
$59K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,283 |
2,741 |
$50K |
| V2020 |
Frames, purchases |
4,376 |
4,337 |
$50K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
641 |
510 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,955 |
1,404 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,052 |
523 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
264 |
263 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
92 |
92 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
55 |
55 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
54 |
27 |
$285.80 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
30 |
15 |
$205.40 |
| 92015 |
Determination of refractive state |
193 |
193 |
$0.00 |