| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,029 |
1,025 |
$80K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
542 |
532 |
$33K |
| 92250 |
|
523 |
521 |
$25K |
| 92225 |
|
864 |
421 |
$12K |
| V2020 |
Frames, purchases |
1,104 |
1,103 |
$6K |
| 68761 |
|
24 |
12 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
438 |
219 |
$2K |
| 92285 |
|
67 |
61 |
$2K |
| 92020 |
|
80 |
79 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
116 |
59 |
$616.20 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
50 |
25 |
$285.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
260 |
130 |
$0.00 |
| V2755 |
U-v lens, per lens |
248 |
124 |
$0.00 |