| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
882 |
882 |
$32K |
| 92250 |
|
273 |
273 |
$6K |
| 92081 |
|
228 |
228 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
126 |
124 |
$4K |
| 92225 |
|
20 |
15 |
$550.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
118 |
59 |
$0.00 |
| V2020 |
Frames, purchases |
625 |
623 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
358 |
196 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
222 |
113 |
$0.00 |
| V2599 |
Contact lens, other type |
129 |
129 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
13 |
$0.00 |