| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
648 |
644 |
$18K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
277 |
275 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
205 |
204 |
$4K |
| 92060 |
|
38 |
37 |
$2K |
| 92283 |
|
38 |
37 |
$2K |
| 92081 |
|
38 |
37 |
$973.37 |
| 92020 |
|
37 |
36 |
$822.88 |
| 92225 |
|
30 |
14 |
$677.70 |
| V2020 |
Frames, purchases |
484 |
482 |
$500.00 |
| 92002 |
|
12 |
12 |
$494.64 |
| V2781 |
Progressive lens, per lens |
117 |
116 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
217 |
216 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
12 |
12 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
140 |
139 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
12 |
12 |
$0.00 |