| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
739 |
729 |
$26K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
123 |
118 |
$5K |
| V2020 |
Frames, purchases |
252 |
252 |
$224.05 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
46 |
46 |
$149.28 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
31 |
31 |
$40.00 |
| 92083 |
|
29 |
29 |
$0.00 |
| 92015 |
Determination of refractive state |
12 |
12 |
$0.00 |
| 92002 |
|
94 |
94 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
16 |
16 |
$0.00 |
| 92250 |
|
16 |
16 |
$0.00 |
| V2112 |
Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens |
19 |
19 |
$0.00 |
| 92285 |
|
35 |
35 |
$0.00 |