| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
1,071 |
1,071 |
$47K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
207 |
207 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
600 |
306 |
$10K |
| 92002 |
|
139 |
139 |
$5K |
| V2020 |
Frames, purchases |
520 |
502 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
138 |
138 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
29 |
$2K |
| 92202 |
|
46 |
46 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
12 |
$0.00 |