| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,808 |
4,628 |
$220K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,845 |
5,601 |
$165K |
| 92015 |
Determination of refractive state |
7,759 |
7,469 |
$112K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,170 |
2,072 |
$97K |
| V2025 |
Deluxe frame |
2,432 |
2,378 |
$76K |
| V2020 |
Frames, purchases |
2,904 |
2,774 |
$56K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,195 |
2,109 |
$28K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
385 |
379 |
$17K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
363 |
360 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,114 |
1,087 |
$14K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
807 |
773 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
784 |
742 |
$9K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
173 |
160 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
56 |
56 |
$1K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
50 |
50 |
$699.09 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
30 |
30 |
$384.36 |