| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,028 |
1,017 |
$77K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
563 |
551 |
$39K |
| V2025 |
Deluxe frame |
623 |
560 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
893 |
880 |
$3K |
| 92015 |
Determination of refractive state |
1,221 |
1,210 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
511 |
461 |
$2K |
| V2020 |
Frames, purchases |
923 |
911 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
61 |
56 |
$956.00 |
| 92341 |
|
76 |
76 |
$25.26 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
33 |
17 |
$14.00 |
| V2756 |
Eye glass case |
545 |
541 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
336 |
246 |
$0.00 |
| 3072F |
|
97 |
97 |
$0.00 |
| 92342 |
|
545 |
541 |
$0.00 |
| 2023F |
|
37 |
37 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
13 |
12 |
$0.00 |
| 2022F |
|
141 |
126 |
$0.00 |
| G0117 |
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
675 |
675 |
$0.00 |