| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92002 |
|
4,084 |
3,975 |
$156K |
| 92015 |
Determination of refractive state |
6,343 |
6,155 |
$129K |
| V2020 |
Frames, purchases |
1,642 |
1,601 |
$109K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
2,041 |
1,961 |
$96K |
| 92100 |
|
2,542 |
2,449 |
$81K |
| 92250 |
|
104 |
104 |
$538.75 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
17 |
14 |
$102.36 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
221 |
216 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
119 |
119 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
26 |
$0.00 |