| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 76512 |
|
2,104 |
1,077 |
$138K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,105 |
1,910 |
$98K |
| 92250 |
|
1,912 |
1,905 |
$86K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,005 |
1,647 |
$50K |
| 92083 |
|
1,091 |
1,090 |
$49K |
| V2020 |
Frames, purchases |
2,488 |
2,444 |
$40K |
| 92285 |
|
1,089 |
1,088 |
$28K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
386 |
231 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
107 |
107 |
$5K |
| 68761 |
|
52 |
26 |
$4K |
| 76514 |
|
409 |
409 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
25 |
25 |
$1K |
| V2755 |
U-v lens, per lens |
1,088 |
539 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
154 |
75 |
$0.00 |