| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
156 |
154 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
233 |
123 |
$5K |
| V2020 |
Frames, purchases |
288 |
287 |
$4K |
| 92250 |
|
52 |
50 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$858.25 |
| 92285 |
|
31 |
31 |
$732.09 |
| 92015 |
Determination of refractive state |
432 |
429 |
$475.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
168 |
84 |
$0.00 |