| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92083 |
|
173 |
170 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
61 |
61 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
238 |
126 |
$4K |
| V2020 |
Frames, purchases |
379 |
377 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
50 |
48 |
$3K |
| 92250 |
|
63 |
62 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$369.72 |
| 92285 |
|
13 |
13 |
$369.19 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
212 |
107 |
$0.00 |