| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
227 |
227 |
$4K |
| V2020 |
Frames, purchases |
427 |
427 |
$3K |
| 92250 |
|
85 |
84 |
$3K |
| 92100 |
|
35 |
34 |
$2K |
| 92083 |
|
29 |
29 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
35 |
34 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
233 |
123 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
44 |
44 |
$880.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
99 |
52 |
$589.54 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
80 |
41 |
$498.68 |
| 76514 |
|
47 |
46 |
$335.76 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
100 |
52 |
$173.12 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
23 |
12 |
$133.22 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
34 |
17 |
$0.00 |