| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,710 |
1,708 |
$106K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,360 |
1,358 |
$71K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,103 |
1,670 |
$57K |
| 92250 |
|
1,280 |
1,277 |
$56K |
| V2020 |
Frames, purchases |
2,408 |
2,394 |
$28K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
377 |
359 |
$14K |
| 92285 |
|
187 |
186 |
$5K |
| 68761 |
|
24 |
12 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
25 |
13 |
$721.64 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,607 |
816 |
$572.00 |
| 92060 |
|
12 |
12 |
$387.86 |
| 92202 |
|
12 |
12 |
$341.95 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$205.40 |
| V2755 |
U-v lens, per lens |
1,068 |
534 |
$0.00 |