| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
1,314 |
1,280 |
$43K |
| 92082 |
|
1,261 |
1,234 |
$18K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,134 |
1,121 |
$13K |
| 92020 |
|
537 |
527 |
$8K |
| 92225 |
|
260 |
134 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
359 |
355 |
$5K |
| 92226 |
|
168 |
87 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
43 |
40 |
$1K |
| 76514 |
|
52 |
52 |
$634.88 |
| 92202 |
|
13 |
13 |
$200.00 |
| 92015 |
Determination of refractive state |
54 |
54 |
$193.60 |
| V2020 |
Frames, purchases |
215 |
214 |
$8.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
52 |
25 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
14 |
$0.00 |