| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,697 |
1,687 |
$99K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,492 |
2,229 |
$81K |
| 92250 |
|
1,187 |
1,172 |
$48K |
| V2020 |
Frames, purchases |
2,571 |
2,552 |
$29K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
82 |
80 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,088 |
1,036 |
$1K |
| 92134 |
|
12 |
12 |
$360.24 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
13 |
$205.40 |
| 92015 |
Determination of refractive state |
929 |
924 |
$0.00 |
| V2755 |
U-v lens, per lens |
1,510 |
749 |
$0.00 |