| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
268 |
266 |
$12K |
| V2020 |
Frames, purchases |
412 |
403 |
$6K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
49 |
49 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
53 |
53 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
129 |
66 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
39 |
39 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
22 |
12 |
$494.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
686 |
337 |
$310.00 |
| 92015 |
Determination of refractive state |
404 |
402 |
$103.74 |