| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
5,422 |
4,639 |
$226K |
| V2020 |
Frames, purchases |
17,110 |
16,767 |
$175K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14,387 |
7,868 |
$162K |
| 92002 |
|
2,376 |
2,373 |
$89K |
| 92250 |
|
1,828 |
1,817 |
$85K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
4,917 |
4,884 |
$67K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,791 |
1,400 |
$61K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,116 |
1,113 |
$44K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
2,544 |
1,311 |
$42K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,894 |
4,165 |
$38K |
| 92285 |
|
1,102 |
1,098 |
$29K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,845 |
2,629 |
$21K |
| 92015 |
Determination of refractive state |
1,764 |
1,762 |
$20K |
| 92341 |
|
678 |
667 |
$13K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
860 |
858 |
$12K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,149 |
767 |
$12K |
| 92083 |
|
208 |
205 |
$10K |
| 92133 |
|
184 |
182 |
$5K |
| 76512 |
|
54 |
54 |
$4K |
| 76514 |
|
412 |
411 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
592 |
373 |
$3K |
| 92082 |
|
64 |
64 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
46 |
46 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
286 |
187 |
$2K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
32 |
32 |
$2K |
| V2112 |
Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens |
68 |
68 |
$1K |
| 92020 |
|
71 |
71 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16 |
16 |
$578.62 |
| 92060 |
|
16 |
16 |
$564.16 |
| 92134 |
|
49 |
49 |
$421.63 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
482 |
228 |
$0.00 |
| 92286 |
|
46 |
46 |
$0.00 |
| G8397 |
Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy |
89 |
58 |
$0.00 |