| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
327 |
283 |
$20K |
| V2025 |
Deluxe frame |
308 |
304 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
208 |
205 |
$7K |
| 92015 |
Determination of refractive state |
808 |
710 |
$5K |
| 92250 |
|
386 |
339 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
16 |
14 |
$1K |
| V2799 |
Vision item or service, miscellaneous |
182 |
175 |
$0.00 |
| V2702 |
Deluxe lens feature |
39 |
38 |
$0.00 |