| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
293 |
266 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
299 |
286 |
$7K |
| 92015 |
Determination of refractive state |
703 |
650 |
$7K |
| 92250 |
|
26 |
25 |
$497.49 |
| 92133 |
|
14 |
14 |
$304.43 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
50 |
50 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
106 |
106 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
21 |
21 |
$0.00 |
| V2020 |
Frames, purchases |
128 |
128 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
105 |
105 |
$0.00 |
| 92341 |
|
21 |
21 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
49 |
49 |
$0.00 |