| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
1,746 |
1,734 |
$79K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,111 |
1,091 |
$63K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
668 |
662 |
$48K |
| 92083 |
|
334 |
328 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
872 |
427 |
$12K |
| 92285 |
|
503 |
488 |
$12K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
282 |
270 |
$12K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
114 |
113 |
$9K |
| V2020 |
Frames, purchases |
798 |
783 |
$8K |
| 92226 |
|
459 |
240 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
91 |
88 |
$5K |
| 92020 |
|
329 |
321 |
$4K |
| 92202 |
|
261 |
201 |
$4K |
| 92225 |
|
232 |
126 |
$3K |
| 92133 |
|
87 |
86 |
$3K |
| 68761 |
|
34 |
24 |
$2K |
| 92060 |
|
44 |
44 |
$1K |
| 68840 |
|
24 |
24 |
$1K |
| 92134 |
|
12 |
12 |
$372.31 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
14 |
$246.48 |
| 92015 |
Determination of refractive state |
66 |
58 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
256 |
127 |
$0.00 |
| V2755 |
U-v lens, per lens |
30 |
15 |
$0.00 |