| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,151 |
4,150 |
$306K |
| 92250 |
|
5,162 |
5,151 |
$226K |
| 92083 |
|
3,290 |
3,285 |
$156K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,344 |
2,339 |
$134K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
7,048 |
3,917 |
$130K |
| 68761 |
|
1,280 |
642 |
$102K |
| V2020 |
Frames, purchases |
5,190 |
5,123 |
$82K |
| 76512 |
|
1,024 |
549 |
$67K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,132 |
682 |
$26K |
| 92285 |
|
1,046 |
1,045 |
$26K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
452 |
440 |
$18K |
| 92225 |
|
567 |
294 |
$8K |
| 92133 |
|
178 |
177 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,482 |
1,822 |
$2K |
| 68801 |
|
33 |
33 |
$2K |
| 92020 |
|
137 |
137 |
$2K |
| 92202 |
|
132 |
86 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
182 |
91 |
$1K |
| 76514 |
|
51 |
51 |
$383.52 |
| V2755 |
U-v lens, per lens |
56 |
28 |
$0.00 |
| V2025 |
Deluxe frame |
15 |
15 |
$0.00 |
| 92015 |
Determination of refractive state |
77 |
77 |
$0.00 |