| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
985 |
931 |
$67K |
| 92015 |
Determination of refractive state |
3,180 |
2,781 |
$65K |
| 92002 |
|
1,123 |
976 |
$44K |
| V2020 |
Frames, purchases |
541 |
493 |
$34K |
| 92250 |
|
659 |
438 |
$20K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
145 |
137 |
$6K |
| 92060 |
|
88 |
86 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
17 |
12 |
$544.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
17 |
12 |
$544.00 |
| V2750 |
Anti-reflective coating, per lens |
29 |
24 |
$68.00 |
| V2744 |
Tint, photochromatic, per lens |
53 |
53 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
64 |
64 |
$0.00 |
| V2025 |
Deluxe frame |
88 |
88 |
$0.00 |
| 2022F |
|
114 |
114 |
$0.00 |