| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
100 |
93 |
$7K |
| 92250 |
|
123 |
112 |
$5K |
| V2025 |
Deluxe frame |
321 |
277 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
74 |
63 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
58 |
57 |
$3K |
| 92083 |
|
68 |
65 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
33 |
27 |
$2K |
| V2020 |
Frames, purchases |
165 |
146 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
248 |
120 |
$2K |
| 92015 |
Determination of refractive state |
233 |
214 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
15 |
15 |
$833.71 |
| 92020 |
|
34 |
32 |
$583.28 |
| 92273 |
|
46 |
44 |
$90.18 |