| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
250 |
247 |
$374.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,621 |
1,586 |
$26.00 |
| V2020 |
Frames, purchases |
1,864 |
1,839 |
$0.00 |
| 92015 |
Determination of refractive state |
933 |
913 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
1,104 |
548 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
13 |
$0.00 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
13 |
12 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
50 |
24 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,478 |
1,469 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,044 |
997 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
748 |
372 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,214 |
1,096 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
124 |
62 |
$0.00 |
| V2781 |
Progressive lens, per lens |
40 |
20 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
40 |
20 |
$0.00 |