| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
392 |
349 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
241 |
230 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
152 |
151 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
88 |
83 |
$5K |
| 92081 |
|
198 |
188 |
$3K |
| 92020 |
|
116 |
93 |
$2K |
| V2025 |
Deluxe frame |
130 |
123 |
$1K |
| 92083 |
|
34 |
19 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
24 |
21 |
$1K |
| 76514 |
|
133 |
120 |
$817.02 |
| 92015 |
Determination of refractive state |
25 |
25 |
$437.90 |