| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,811 |
1,798 |
$123K |
| 92250 |
|
976 |
969 |
$42K |
| 92285 |
|
898 |
891 |
$24K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,268 |
788 |
$24K |
| V2020 |
Frames, purchases |
1,111 |
1,102 |
$18K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
119 |
119 |
$6K |
| 92083 |
|
81 |
81 |
$4K |
| 92133 |
|
15 |
15 |
$450.30 |
| 92060 |
|
12 |
12 |
$423.12 |
| 92015 |
Determination of refractive state |
26 |
26 |
$247.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
14 |
$210.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
15 |
$36.00 |