| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
5,341 |
5,326 |
$243K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,114 |
3,113 |
$222K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,042 |
3,033 |
$180K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
9,574 |
5,149 |
$132K |
| V2020 |
Frames, purchases |
9,346 |
9,262 |
$103K |
| 92285 |
|
3,075 |
3,055 |
$74K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,521 |
3,516 |
$47K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,213 |
3,438 |
$34K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
7,383 |
3,940 |
$25K |
| V2219 |
Bifocal seg width over 28 mm |
323 |
322 |
$25K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
378 |
377 |
$22K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
1,536 |
1,533 |
$20K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
896 |
483 |
$17K |
| 92015 |
Determination of refractive state |
1,268 |
1,267 |
$15K |
| 92225 |
|
579 |
314 |
$9K |
| 76512 |
|
110 |
56 |
$7K |
| 92341 |
|
332 |
332 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
394 |
291 |
$5K |
| 92060 |
|
61 |
61 |
$2K |
| 92083 |
|
14 |
14 |
$651.00 |
| 76514 |
|
98 |
98 |
$631.61 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$468.00 |
| 92202 |
|
20 |
12 |
$289.29 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
16 |
16 |
$285.00 |
| 92020 |
|
18 |
18 |
$30.02 |
| V2755 |
U-v lens, per lens |
5,171 |
2,567 |
$0.00 |