| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
7,839 |
6,711 |
$333K |
| 92004 |
|
3,160 |
2,743 |
$213K |
| 92015 |
|
11,590 |
9,280 |
$64K |
| 99214 |
|
1,053 |
748 |
$28K |
| 99213 |
|
1,072 |
922 |
$18K |
| 66984 |
|
123 |
65 |
$16K |
| 92340 |
|
359 |
260 |
$4K |
| 92136 |
|
302 |
224 |
$4K |
| 92134 |
|
240 |
211 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
88 |
88 |
$2K |
| 92133 |
|
193 |
163 |
$2K |
| 99204 |
|
27 |
25 |
$2K |
| 92020 |
|
123 |
105 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
15 |
15 |
$525.00 |
| 92012 |
|
32 |
24 |
$411.94 |
| 92250 |
|
16 |
14 |
$316.46 |
| V2750 |
Anti-reflective coating, per lens |
176 |
140 |
$150.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
164 |
130 |
$37.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
128 |
102 |
$17.20 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
22 |
$8.60 |
| V2020 |
Frames, purchases |
160 |
128 |
$8.00 |