| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,524 |
1,521 |
$37K |
| V2020 |
Frames, purchases |
1,505 |
1,497 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
176 |
176 |
$6K |
| 92250 |
|
147 |
147 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
205 |
203 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
518 |
517 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
550 |
547 |
$5K |
| 92015 |
Determination of refractive state |
1,028 |
1,028 |
$4K |
| 92081 |
|
112 |
112 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
135 |
135 |
$2K |
| 92285 |
|
53 |
53 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
24 |
24 |
$481.00 |