| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
10,424 |
10,417 |
$316K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13,316 |
8,697 |
$230K |
| V2020 |
Frames, purchases |
10,528 |
10,499 |
$141K |
| 92285 |
|
706 |
601 |
$70K |
| 92250 |
|
1,008 |
1,007 |
$45K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,125 |
1,539 |
$26K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,655 |
2,153 |
$18K |
| 92025 |
|
839 |
837 |
$16K |
| 92015 |
Determination of refractive state |
3,642 |
3,640 |
$11K |
| 92083 |
|
209 |
208 |
$10K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
383 |
326 |
$6K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
68 |
68 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
148 |
148 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
143 |
142 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
63 |
63 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,505 |
1,494 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
38 |
24 |
$941.62 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
18 |
12 |
$286.32 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
20 |
12 |
$148.16 |
| V2755 |
U-v lens, per lens |
566 |
283 |
$0.00 |