| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
961 |
956 |
$27K |
| V2020 |
Frames, purchases |
2,249 |
2,237 |
$25K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
621 |
618 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,587 |
871 |
$20K |
| 92341 |
|
342 |
340 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
801 |
485 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
817 |
465 |
$5K |
| 92015 |
Determination of refractive state |
251 |
251 |
$2K |
| 99243 |
|
13 |
13 |
$915.96 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
31 |
16 |
$870.00 |
| 99242 |
|
15 |
14 |
$713.84 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
42 |
41 |
$615.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
14 |
14 |
$600.88 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
13 |
13 |
$234.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
22 |
12 |
$98.56 |
| V2755 |
U-v lens, per lens |
196 |
98 |
$0.00 |