| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,852 |
1,840 |
$62K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,526 |
1,520 |
$31K |
| V2020 |
Frames, purchases |
1,725 |
1,719 |
$26K |
| 92250 |
|
429 |
427 |
$18K |
| 92285 |
|
442 |
381 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
405 |
400 |
$4K |
| 92025 |
|
87 |
87 |
$2K |
| 92082 |
|
26 |
26 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
28 |
28 |
$1K |
| 92083 |
|
18 |
18 |
$837.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$567.50 |