| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
6,420 |
6,127 |
$305K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
6,415 |
5,622 |
$261K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
955 |
942 |
$41K |
| V2020 |
Frames, purchases |
493 |
439 |
$32K |
| 92015 |
Determination of refractive state |
2,012 |
1,810 |
$32K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
216 |
210 |
$28K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,173 |
1,133 |
$22K |
| V2025 |
Deluxe frame |
359 |
357 |
$15K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
167 |
164 |
$15K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
229 |
226 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
490 |
457 |
$9K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
87 |
85 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
290 |
279 |
$6K |
| 68761 |
|
48 |
13 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
43 |
43 |
$2K |
| 92341 |
|
27 |
27 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
109 |
109 |
$300.56 |
| 92250 |
|
13 |
12 |
$297.76 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
16 |
16 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
17 |
17 |
$0.00 |