| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,273 |
4,268 |
$307K |
| 92250 |
|
4,651 |
4,640 |
$213K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,176 |
2,172 |
$129K |
| V2020 |
Frames, purchases |
8,182 |
8,013 |
$120K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,973 |
3,970 |
$107K |
| 92285 |
|
4,715 |
4,701 |
$107K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,344 |
1,296 |
$54K |
| 76512 |
|
596 |
302 |
$40K |
| 92083 |
|
655 |
654 |
$31K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,500 |
841 |
$29K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,007 |
2,004 |
$27K |
| 92015 |
Determination of refractive state |
2,014 |
2,011 |
$23K |
| 92133 |
|
701 |
699 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,069 |
1,710 |
$17K |
| 92202 |
|
950 |
558 |
$16K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
229 |
229 |
$13K |
| 68761 |
|
126 |
65 |
$9K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
1,010 |
1,006 |
$9K |
| 76514 |
|
751 |
749 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,663 |
1,879 |
$4K |
| 92273 |
|
67 |
64 |
$4K |
| 92134 |
|
44 |
44 |
$1K |
| 92020 |
|
496 |
494 |
$1K |
| 92082 |
|
28 |
28 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
49 |
31 |
$424.72 |
| 92286 |
|
35 |
35 |
$0.00 |
| V2755 |
U-v lens, per lens |
34 |
17 |
$0.00 |
| 92025 |
|
30 |
30 |
$0.00 |