| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,251 |
1,231 |
$60K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,422 |
1,197 |
$43K |
| 92250 |
|
668 |
628 |
$26K |
| 92285 |
|
638 |
637 |
$18K |
| V2020 |
Frames, purchases |
1,525 |
1,504 |
$15K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
55 |
54 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
36 |
17 |
$205.40 |
| 92286 |
|
564 |
557 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,010 |
499 |
$0.00 |
| 92025 |
|
547 |
541 |
$0.00 |