| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,865 |
1,863 |
$73K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,815 |
1,499 |
$47K |
| V2020 |
Frames, purchases |
2,875 |
2,846 |
$26K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
342 |
183 |
$5K |
| 92002 |
|
95 |
95 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,353 |
1,656 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$573.75 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
21 |
14 |
$492.46 |
| V2755 |
U-v lens, per lens |
1,008 |
500 |
$0.00 |