| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
2,752 |
2,740 |
$124K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,657 |
1,648 |
$122K |
| 76512 |
|
1,841 |
939 |
$113K |
| 92083 |
|
1,869 |
1,824 |
$87K |
| 92285 |
|
2,697 |
2,686 |
$74K |
| 92060 |
|
1,662 |
1,653 |
$61K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
777 |
777 |
$45K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,059 |
1,150 |
$35K |
| V2020 |
Frames, purchases |
1,928 |
1,915 |
$21K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
44 |
42 |
$2K |
| 92225 |
|
74 |
38 |
$1K |
| 92202 |
|
26 |
26 |
$646.32 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
23 |
12 |
$576.64 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
168 |
84 |
$534.04 |
| V2755 |
U-v lens, per lens |
800 |
397 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
72 |
36 |
$0.00 |