| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,875 |
1,831 |
$135K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,374 |
1,318 |
$118K |
| V2020 |
Frames, purchases |
4,190 |
4,119 |
$80K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,512 |
3,448 |
$76K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,550 |
1,541 |
$47K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
396 |
392 |
$7K |
| V2781 |
Progressive lens, per lens |
200 |
197 |
$6K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
107 |
106 |
$1K |
| 92250 |
|
44 |
43 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
42 |
42 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$350.35 |
| V2750 |
Anti-reflective coating, per lens |
15 |
15 |
$261.80 |
| V2755 |
U-v lens, per lens |
14 |
14 |
$17.46 |
| V2799 |
Vision item or service, miscellaneous |
12 |
12 |
$0.72 |
| 92015 |
Determination of refractive state |
27 |
27 |
$0.00 |