| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
455 |
454 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
241 |
241 |
$16K |
| 92285 |
|
419 |
419 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
75 |
74 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
218 |
104 |
$4K |
| V2020 |
Frames, purchases |
244 |
233 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
19 |
18 |
$702.00 |
| 92133 |
|
17 |
17 |
$480.32 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
54 |
27 |
$0.00 |