| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,847 |
2,812 |
$252K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,414 |
1,388 |
$148K |
| V2020 |
Frames, purchases |
4,238 |
4,119 |
$114K |
| 92015 |
Determination of refractive state |
4,536 |
4,431 |
$62K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,982 |
1,936 |
$47K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
497 |
471 |
$30K |
| 92250 |
|
520 |
509 |
$28K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
615 |
601 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
532 |
522 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
602 |
588 |
$5K |
| 92083 |
|
66 |
59 |
$3K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
26 |
26 |
$658.84 |