| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
484 |
474 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
188 |
186 |
$9K |
| 92285 |
|
115 |
112 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
260 |
257 |
$7K |
| V2020 |
Frames, purchases |
26 |
26 |
$563.00 |
| 92060 |
|
14 |
14 |
$465.78 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$349.24 |
| 92020 |
|
58 |
58 |
$345.76 |
| 92133 |
|
28 |
28 |
$262.49 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$256.14 |
| 92015 |
Determination of refractive state |
562 |
556 |
$250.16 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
12 |
$110.00 |