| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
890 |
890 |
$11K |
| V2020 |
Frames, purchases |
1,960 |
1,954 |
$9K |
| 92002 |
|
168 |
168 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,150 |
632 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
285 |
285 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
562 |
325 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
30 |
30 |
$800.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
64 |
41 |
$745.12 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
74 |
39 |
$431.62 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
14 |
14 |
$222.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
52 |
52 |
$0.00 |
| 92015 |
Determination of refractive state |
20 |
20 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
330 |
166 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$0.00 |
| V2755 |
U-v lens, per lens |
656 |
328 |
$0.00 |