| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
262 |
260 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
124 |
123 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
90 |
87 |
$6K |
| V2020 |
Frames, purchases |
755 |
755 |
$6K |
| 92285 |
|
235 |
233 |
$5K |
| 92283 |
|
61 |
58 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
188 |
188 |
$2K |
| 92341 |
|
61 |
61 |
$2K |
| 92015 |
Determination of refractive state |
124 |
124 |
$2K |
| V2211 |
Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens |
24 |
24 |
$799.20 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
44 |
44 |
$783.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
37 |
37 |
$699.30 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
36 |
36 |
$237.60 |