| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,706 |
1,698 |
$176K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,345 |
1,289 |
$101K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
594 |
594 |
$47K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,975 |
1,511 |
$42K |
| 92133 |
|
910 |
908 |
$27K |
| V2020 |
Frames, purchases |
2,097 |
2,077 |
$25K |
| 92202 |
|
1,136 |
1,029 |
$13K |
| 92250 |
|
194 |
194 |
$9K |
| 92134 |
|
265 |
265 |
$8K |
| 92002 |
|
77 |
77 |
$6K |
| 92020 |
|
167 |
166 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
242 |
121 |
$698.36 |
| 92226 |
|
147 |
74 |
$485.96 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
20 |
13 |
$192.16 |
| 92285 |
|
66 |
66 |
$72.06 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
930 |
472 |
$43.00 |
| 83861 |
|
26 |
26 |
$0.00 |
| 92015 |
Determination of refractive state |
65 |
65 |
$0.00 |
| 92225 |
|
26 |
12 |
$0.00 |