| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
3,187 |
3,033 |
$115K |
| 92014 |
|
4,897 |
4,864 |
$97K |
| 92340 |
|
2,897 |
2,842 |
$54K |
| 92004 |
|
1,980 |
1,960 |
$39K |
| 99213 |
|
729 |
670 |
$26K |
| 92015 |
|
4,738 |
4,662 |
$11K |
| 99212 |
|
97 |
92 |
$3K |
| V2020 |
Frames, purchases |
4,196 |
4,160 |
$20.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,513 |
2,236 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
896 |
467 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,521 |
2,267 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
26 |
13 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
59 |
59 |
$0.00 |
| V2781 |
Progressive lens, per lens |
26 |
13 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
13 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
297 |
149 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
99 |
99 |
$0.00 |