| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
850 |
845 |
$13K |
| V2020 |
Frames, purchases |
739 |
734 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
719 |
411 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
195 |
111 |
$969.38 |
| 92015 |
Determination of refractive state |
154 |
152 |
$410.20 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$326.40 |
| 92250 |
|
12 |
12 |
$240.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
24 |
$126.00 |
| V2750 |
Anti-reflective coating, per lens |
30 |
15 |
$0.00 |
| 3072F |
|
13 |
13 |
$0.00 |