| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
936 |
931 |
$22K |
| V2020 |
Frames, purchases |
3,447 |
3,428 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,282 |
1,488 |
$8K |
| 92002 |
|
790 |
787 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,768 |
1,163 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
209 |
158 |
$2K |
| 92015 |
Determination of refractive state |
569 |
568 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
519 |
519 |
$389.20 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
461 |
461 |
$166.80 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
12 |
12 |
$100.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,563 |
987 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
78 |
78 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
28 |
14 |
$0.00 |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
57 |
56 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
670 |
468 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
56 |
56 |
$0.00 |