| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
888 |
851 |
$57K |
| V2025 |
Deluxe frame |
896 |
891 |
$48K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
221 |
221 |
$27K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
619 |
617 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,124 |
1,088 |
$25K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,308 |
1,255 |
$23K |
| V2020 |
Frames, purchases |
1,086 |
1,061 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
396 |
390 |
$6K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
327 |
314 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
67 |
67 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
25 |
25 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
29 |
28 |
$435.90 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
13 |
13 |
$410.57 |
| 92015 |
Determination of refractive state |
60 |
60 |
$0.00 |