| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92285 |
|
560 |
557 |
$39K |
| 92286 |
|
486 |
481 |
$33K |
| 92250 |
|
632 |
629 |
$26K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,042 |
699 |
$20K |
| 92083 |
|
422 |
417 |
$19K |
| V2020 |
Frames, purchases |
219 |
216 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
111 |
104 |
$2K |
| 92002 |
|
73 |
72 |
$2K |
| 68801 |
|
31 |
25 |
$1K |
| 92025 |
|
57 |
57 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$300.00 |
| 76512 |
|
12 |
12 |
$279.60 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |
| 92015 |
Determination of refractive state |
17 |
17 |
$0.00 |