| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,378 |
1,364 |
$136K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,113 |
1,087 |
$130K |
| V2025 |
Deluxe frame |
1,730 |
1,708 |
$78K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,329 |
1,741 |
$51K |
| 92015 |
Determination of refractive state |
2,736 |
2,687 |
$41K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
340 |
335 |
$18K |
| V2020 |
Frames, purchases |
914 |
890 |
$18K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
275 |
274 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
373 |
290 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
279 |
276 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
196 |
161 |
$4K |
| 92060 |
|
25 |
24 |
$1K |
| 92250 |
|
24 |
24 |
$1K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
27 |
24 |
$770.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
28 |
24 |
$558.50 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
16 |
13 |
$494.00 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
17 |
12 |
$263.50 |
| V2750 |
Anti-reflective coating, per lens |
50 |
49 |
$32.34 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
45 |
45 |
$0.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
14 |
14 |
$0.00 |