| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,660 |
3,655 |
$207K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,970 |
1,968 |
$135K |
| V2020 |
Frames, purchases |
5,113 |
5,024 |
$115K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,427 |
2,800 |
$102K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,954 |
3,677 |
$17K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,181 |
1,179 |
$17K |
| 92133 |
|
364 |
363 |
$11K |
| 92083 |
|
177 |
175 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
330 |
279 |
$8K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
129 |
120 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
177 |
131 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
84 |
67 |
$2K |
| 92341 |
|
58 |
58 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
21 |
21 |
$840.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
37 |
25 |
$822.64 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
18 |
18 |
$720.00 |
| 92250 |
|
13 |
13 |
$444.56 |
| 76514 |
|
37 |
37 |
$341.49 |
| 92015 |
Determination of refractive state |
1,444 |
1,441 |
$59.33 |