| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
1,240 |
1,223 |
$55K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,164 |
1,095 |
$45K |
| 92083 |
|
997 |
996 |
$42K |
| 92285 |
|
1,377 |
1,295 |
$30K |
| V2020 |
Frames, purchases |
1,778 |
1,772 |
$27K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,582 |
951 |
$25K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
652 |
335 |
$13K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
152 |
152 |
$6K |
| 92002 |
|
349 |
349 |
$6K |
| 76512 |
|
13 |
13 |
$803.76 |
| 76514 |
|
75 |
74 |
$586.51 |
| 92133 |
|
12 |
12 |
$360.24 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
144 |
71 |
$12.00 |
| 92286 |
|
15 |
15 |
$0.00 |
| 76513 |
|
16 |
16 |
$0.00 |
| 92025 |
|
12 |
12 |
$0.00 |
| 92015 |
Determination of refractive state |
14 |
14 |
$0.00 |