| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,495 |
1,336 |
$121K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,056 |
953 |
$115K |
| V2020 |
Frames, purchases |
1,956 |
1,793 |
$87K |
| 92015 |
Determination of refractive state |
3,167 |
2,936 |
$41K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
523 |
471 |
$27K |
| V2755 |
U-v lens, per lens |
111 |
111 |
$3K |
| 92250 |
|
77 |
72 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
38 |
38 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$984.33 |
| 92002 |
|
12 |
12 |
$755.63 |
| 92083 |
|
14 |
14 |
$489.03 |
| 92134 |
|
13 |
12 |
$305.07 |