| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
899 |
870 |
$32K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,031 |
1,014 |
$11K |
| 92134 |
|
403 |
358 |
$8K |
| 92235 |
|
101 |
99 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
251 |
230 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
814 |
809 |
$5K |
| 92136 |
|
12 |
12 |
$168.84 |
| V2020 |
Frames, purchases |
1,458 |
1,436 |
$0.00 |
| 92015 |
Determination of refractive state |
1,317 |
1,312 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
26 |
13 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
16 |
16 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,858 |
923 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
90 |
45 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
28 |
14 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
24 |
12 |
$0.00 |