| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,891 |
4,867 |
$139K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,886 |
4,865 |
$104K |
| V2020 |
Frames, purchases |
5,817 |
5,800 |
$96K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,132 |
1,127 |
$34K |
| 92250 |
|
640 |
631 |
$29K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,729 |
1,721 |
$15K |
| 92285 |
|
481 |
452 |
$14K |
| 92025 |
|
268 |
265 |
$6K |
| 92082 |
|
178 |
178 |
$6K |
| 68761 |
|
12 |
12 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
65 |
64 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
14 |
$537.56 |
| 92133 |
|
13 |
13 |
$440.05 |
| 92002 |
|
39 |
38 |
$0.00 |