| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
428 |
428 |
$19K |
| 92250 |
|
335 |
328 |
$15K |
| 92083 |
|
236 |
234 |
$12K |
| V2020 |
Frames, purchases |
416 |
410 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
235 |
231 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
108 |
107 |
$4K |
| 68761 |
|
24 |
16 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
26 |
$204.00 |
| 92015 |
Determination of refractive state |
18 |
18 |
$0.00 |