| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,413 |
1,412 |
$98K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,524 |
1,505 |
$63K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,789 |
1,782 |
$39K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,753 |
1,717 |
$35K |
| V2020 |
Frames, purchases |
2,060 |
2,021 |
$33K |
| V2025 |
Deluxe frame |
414 |
409 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
125 |
125 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
423 |
422 |
$11K |
| 92015 |
Determination of refractive state |
1,372 |
1,372 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
91 |
91 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
129 |
128 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
13 |
$576.50 |