| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,868 |
1,858 |
$927.15 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
29 |
24 |
$440.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,298 |
1,294 |
$132.00 |
| 92250 |
|
12 |
12 |
$56.76 |
| V2020 |
Frames, purchases |
2,540 |
2,516 |
$0.00 |
| 92015 |
Determination of refractive state |
1,000 |
999 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
62 |
62 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
39 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,324 |
1,315 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,333 |
1,323 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
135 |
135 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
244 |
244 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
402 |
397 |
$0.00 |
| 92310 |
|
39 |
39 |
$0.00 |