| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,949 |
1,945 |
$25K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,179 |
1,169 |
$16K |
| V2020 |
Frames, purchases |
2,947 |
2,922 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,950 |
1,949 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,574 |
1,013 |
$8K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
714 |
554 |
$6K |
| 92015 |
Determination of refractive state |
1,448 |
1,432 |
$2K |
| 92286 |
|
18 |
18 |
$156.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
54 |
32 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
18 |
18 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
51 |
31 |
$0.00 |