| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
579 |
572 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
369 |
350 |
$5K |
| 92250 |
|
29 |
29 |
$1K |
| 92082 |
|
43 |
43 |
$688.00 |
| 92015 |
Determination of refractive state |
275 |
273 |
$363.00 |
| V2020 |
Frames, purchases |
490 |
485 |
$100.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
553 |
287 |
$42.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
71 |
38 |
$0.00 |
| S0500 |
Disposable contact lens, per lens |
13 |
13 |
$0.00 |