| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 68761 |
|
4,134 |
2,058 |
$317K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,642 |
1,570 |
$76K |
| 92250 |
|
1,505 |
1,458 |
$50K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,840 |
1,486 |
$48K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
838 |
809 |
$47K |
| 92082 |
|
1,387 |
1,348 |
$45K |
| V2020 |
Frames, purchases |
1,964 |
1,868 |
$20K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
211 |
200 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,518 |
1,262 |
$2K |
| 92015 |
Determination of refractive state |
262 |
251 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
55 |
28 |
$626.10 |
| 83861 |
|
28 |
12 |
$321.60 |
| 92081 |
|
15 |
14 |
$253.07 |
| V2755 |
U-v lens, per lens |
90 |
44 |
$0.00 |
| 2022F |
|
101 |
98 |
$0.00 |