| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,081 |
3,060 |
$111K |
| 92250 |
|
1,854 |
1,845 |
$83K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,125 |
1,061 |
$45K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,258 |
1,214 |
$36K |
| 92202 |
|
1,267 |
1,258 |
$29K |
| 92285 |
|
1,005 |
962 |
$27K |
| 92083 |
|
539 |
536 |
$26K |
| V2020 |
Frames, purchases |
1,810 |
1,791 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
291 |
288 |
$14K |
| 92226 |
|
453 |
447 |
$10K |
| 92133 |
|
298 |
296 |
$8K |
| 92015 |
Determination of refractive state |
1,696 |
1,692 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
216 |
108 |
$903.76 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,330 |
1,189 |
$716.00 |
| V2755 |
U-v lens, per lens |
24 |
12 |
$0.00 |