| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,951 |
1,941 |
$141K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,308 |
2,277 |
$135K |
| 92250 |
|
2,453 |
2,413 |
$114K |
| V2020 |
Frames, purchases |
5,507 |
5,425 |
$62K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,459 |
2,432 |
$33K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,255 |
1,321 |
$33K |
| 92015 |
Determination of refractive state |
2,756 |
2,702 |
$33K |
| 92083 |
|
630 |
626 |
$31K |
| 68761 |
|
318 |
230 |
$30K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
1,471 |
1,458 |
$24K |
| 92285 |
|
622 |
621 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
238 |
220 |
$9K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
26 |
25 |
$8K |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
362 |
359 |
$7K |
| 92341 |
|
343 |
342 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
757 |
593 |
$6K |
| V2202 |
Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00d, per lens |
132 |
132 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
149 |
130 |
$3K |
| 92060 |
|
88 |
87 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
80 |
79 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
61 |
55 |
$1K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
87 |
87 |
$1K |
| 92202 |
|
67 |
64 |
$972.32 |