| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,921 |
2,205 |
$127K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,707 |
2,051 |
$116K |
| 92015 |
Determination of refractive state |
4,413 |
3,862 |
$71K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
702 |
545 |
$56K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,739 |
1,503 |
$47K |
| 92341 |
|
1,530 |
1,227 |
$40K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
920 |
735 |
$35K |
| V2020 |
Frames, purchases |
1,063 |
1,009 |
$26K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
368 |
321 |
$16K |
| V2025 |
Deluxe frame |
1,005 |
751 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
280 |
280 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
19 |
19 |
$855.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
15 |
15 |
$675.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$318.56 |
| 99072 |
|
181 |
171 |
$0.00 |
| S0581 |
Nonstandard lens (list this code in addition to the basic code for the lens) |
15 |
15 |
$0.00 |