| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,093 |
1,030 |
$6K |
| 92250 |
|
120 |
120 |
$5K |
| 92225 |
|
94 |
65 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
256 |
254 |
$2K |
| 92133 |
|
57 |
57 |
$1K |
| 92020 |
|
55 |
55 |
$880.00 |
| 92083 |
|
49 |
49 |
$784.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
64 |
64 |
$468.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,682 |
1,332 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,150 |
571 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
104 |
52 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
26 |
13 |
$0.00 |
| V2781 |
Progressive lens, per lens |
26 |
13 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
2,003 |
992 |
$0.00 |
| 92015 |
Determination of refractive state |
804 |
802 |
$0.00 |
| V2020 |
Frames, purchases |
359 |
354 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$0.00 |