| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,840 |
1,740 |
$138K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,856 |
1,740 |
$109K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
2,566 |
2,217 |
$102K |
| 92015 |
Determination of refractive state |
1,839 |
1,667 |
$24K |
| 92250 |
|
337 |
313 |
$6K |
| 92201 |
|
223 |
209 |
$3K |
| V2020 |
Frames, purchases |
111 |
108 |
$3K |
| V2025 |
Deluxe frame |
27 |
27 |
$1K |
| 92133 |
|
38 |
37 |
$920.78 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
14 |
$365.27 |
| 92020 |
|
15 |
15 |
$227.70 |
| 99199 |
Unlisted special service, procedure or report |
25 |
25 |
$0.00 |