| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,868 |
1,836 |
$6K |
| 92250 |
|
132 |
132 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
435 |
435 |
$2K |
| 92083 |
|
88 |
88 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
249 |
245 |
$2K |
| 92020 |
|
26 |
26 |
$419.20 |
| 76514 |
|
14 |
14 |
$143.00 |
| 92002 |
|
14 |
14 |
$22.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,938 |
1,513 |
$20.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,275 |
670 |
$11.60 |
| V2020 |
Frames, purchases |
2,103 |
2,098 |
$8.00 |
| V2760 |
Scratch resistant coating, per lens |
484 |
263 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
927 |
466 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
443 |
229 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
106 |
106 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
619 |
313 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,562 |
811 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
122 |
61 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
36 |
36 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
120 |
62 |
$0.00 |
| V2781 |
Progressive lens, per lens |
238 |
118 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
24 |
12 |
$0.00 |