| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
239 |
236 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
28 |
27 |
$792.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
133 |
133 |
$86.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
141 |
141 |
$43.00 |
| V2020 |
Frames, purchases |
275 |
275 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
24 |
12 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
101 |
55 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
44 |
44 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
14 |
$0.00 |