| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
931 |
908 |
$38K |
| V2020 |
Frames, purchases |
1,681 |
1,657 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,034 |
860 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
344 |
172 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
92 |
92 |
$4K |
| 92082 |
|
89 |
89 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,737 |
1,022 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
107 |
91 |
$3K |
| 92250 |
|
43 |
43 |
$2K |
| 92020 |
|
12 |
12 |
$180.12 |
| 76514 |
|
12 |
12 |
$95.88 |