| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
480 |
416 |
$24K |
| V2025 |
Deluxe frame |
222 |
197 |
$10K |
| 92250 |
|
196 |
187 |
$8K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
155 |
147 |
$7K |
| V2020 |
Frames, purchases |
297 |
287 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
264 |
241 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
28 |
28 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
34 |
33 |
$2K |
| 92273 |
|
25 |
24 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
25 |
$654.73 |
| 92015 |
Determination of refractive state |
97 |
83 |
$623.12 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$560.67 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
45 |
45 |
$533.00 |