| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
366 |
223 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
193 |
117 |
$11K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
58 |
52 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
124 |
100 |
$5K |
| V2025 |
Deluxe frame |
159 |
104 |
$2K |
| V2020 |
Frames, purchases |
26 |
26 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$1K |
| 92015 |
Determination of refractive state |
79 |
79 |
$790.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$180.04 |