| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,815 |
1,801 |
$68K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
888 |
867 |
$48K |
| 92250 |
|
676 |
665 |
$30K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,032 |
604 |
$27K |
| V2020 |
Frames, purchases |
1,952 |
1,934 |
$27K |
| 92083 |
|
437 |
433 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,054 |
714 |
$19K |
| 76512 |
|
223 |
110 |
$13K |
| 92286 |
|
124 |
123 |
$12K |
| 92226 |
|
711 |
381 |
$12K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
171 |
171 |
$7K |
| 92285 |
|
141 |
141 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
127 |
103 |
$2K |
| 68040 |
|
59 |
55 |
$2K |
| 92025 |
|
78 |
77 |
$2K |
| 92020 |
|
31 |
31 |
$465.31 |
| 92133 |
|
12 |
12 |
$406.20 |
| 92002 |
|
13 |
13 |
$396.74 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
797 |
451 |
$329.50 |
| 92015 |
Determination of refractive state |
339 |
337 |
$0.00 |