| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
1,249 |
1,245 |
$57K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
736 |
680 |
$39K |
| 92285 |
|
955 |
954 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
827 |
477 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
250 |
245 |
$13K |
| V2020 |
Frames, purchases |
692 |
685 |
$9K |
| 68761 |
|
56 |
25 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
27 |
26 |
$1K |
| 92286 |
|
47 |
45 |
$386.72 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
937 |
465 |
$66.00 |
| 92015 |
Determination of refractive state |
17 |
17 |
$62.70 |