| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
4,168 |
3,982 |
$199K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,622 |
2,493 |
$199K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,458 |
1,411 |
$129K |
| V2020 |
Frames, purchases |
4,564 |
4,363 |
$124K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,676 |
3,489 |
$109K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,170 |
1,105 |
$60K |
| 92015 |
Determination of refractive state |
4,562 |
4,321 |
$56K |
| 92025 |
|
1,647 |
1,545 |
$37K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
818 |
808 |
$31K |
| V2025 |
Deluxe frame |
451 |
435 |
$22K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
404 |
401 |
$17K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
308 |
292 |
$12K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
17 |
12 |
$612.17 |
| 92145 |
|
128 |
126 |
$48.38 |