| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
381 |
381 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
167 |
164 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
111 |
110 |
$6K |
| 92015 |
Determination of refractive state |
315 |
307 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
89 |
87 |
$4K |
| 92250 |
|
80 |
79 |
$3K |
| V2025 |
Deluxe frame |
105 |
103 |
$3K |