| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,407 |
1,394 |
$92K |
| 92250 |
|
1,423 |
1,418 |
$62K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,341 |
1,214 |
$46K |
| V2020 |
Frames, purchases |
2,597 |
2,575 |
$31K |
| 92285 |
|
1,161 |
1,126 |
$31K |
| 76512 |
|
394 |
222 |
$26K |
| 92083 |
|
396 |
395 |
$19K |
| 92002 |
|
428 |
428 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
907 |
907 |
$13K |
| 92060 |
|
265 |
264 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,128 |
706 |
$7K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
238 |
123 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
434 |
401 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
137 |
137 |
$4K |
| 92082 |
|
101 |
101 |
$4K |
| 92015 |
Determination of refractive state |
130 |
130 |
$2K |
| 92341 |
|
120 |
120 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
34 |
34 |
$2K |
| 92286 |
|
15 |
15 |
$528.66 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
14 |
$166.64 |
| 76514 |
|
15 |
15 |
$157.85 |
| 92020 |
|
12 |
12 |
$54.60 |