| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92002 |
|
2,931 |
2,639 |
$96K |
| 92015 |
Determination of refractive state |
3,582 |
3,151 |
$66K |
| V2020 |
Frames, purchases |
539 |
486 |
$48K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
316 |
224 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
91 |
89 |
$3K |
| 92100 |
|
46 |
45 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
36 |
18 |
$405.00 |
| 2022F |
|
114 |
110 |
$0.00 |
| 3072F |
|
20 |
20 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
14 |
$0.00 |