| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
637 |
633 |
$29K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,891 |
911 |
$28K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
395 |
392 |
$21K |
| V2020 |
Frames, purchases |
1,942 |
1,874 |
$19K |
| 92250 |
|
333 |
330 |
$14K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
133 |
67 |
$3K |
| 92020 |
|
176 |
174 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
57 |
55 |
$2K |
| 92083 |
|
35 |
34 |
$1K |
| 92202 |
|
18 |
18 |
$631.24 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
116 |
56 |
$534.04 |
| 92133 |
|
17 |
17 |
$514.51 |
| 92015 |
Determination of refractive state |
315 |
310 |
$273.60 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
578 |
280 |
$140.00 |
| V2755 |
U-v lens, per lens |
374 |
167 |
$0.00 |