| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
2,423 |
2,419 |
$111K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,414 |
1,411 |
$105K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,608 |
1,601 |
$97K |
| 92083 |
|
921 |
920 |
$42K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,566 |
858 |
$24K |
| V2020 |
Frames, purchases |
1,921 |
1,905 |
$20K |
| 92020 |
|
882 |
881 |
$13K |
| 92226 |
|
803 |
418 |
$12K |
| 92225 |
|
714 |
381 |
$11K |
| 99215 |
Prolong outpt/office vis |
18 |
18 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
30 |
$575.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
108 |
54 |
$369.72 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
13 |
$262.50 |
| 92285 |
|
12 |
12 |
$233.42 |
| 92341 |
|
123 |
123 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
480 |
237 |
$0.00 |
| V2755 |
U-v lens, per lens |
396 |
198 |
$0.00 |