| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,659 |
2,635 |
$182K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,031 |
968 |
$111K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,978 |
3,915 |
$80K |
| V2025 |
Deluxe frame |
1,003 |
885 |
$66K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
658 |
640 |
$66K |
| 92341 |
|
1,997 |
1,909 |
$55K |
| V2219 |
Bifocal seg width over 28 mm |
640 |
566 |
$53K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
714 |
665 |
$48K |
| V2020 |
Frames, purchases |
745 |
743 |
$42K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
383 |
334 |
$40K |
| V2760 |
Scratch resistant coating, per lens |
1,165 |
1,049 |
$35K |
| V2750 |
Anti-reflective coating, per lens |
444 |
430 |
$15K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
80 |
80 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
154 |
120 |
$8K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
35 |
35 |
$5K |
| 92015 |
Determination of refractive state |
317 |
305 |
$5K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
45 |
45 |
$3K |
| 92250 |
|
32 |
31 |
$654.58 |