| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
707 |
690 |
$28K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,090 |
1,086 |
$26K |
| V2020 |
Frames, purchases |
1,291 |
1,283 |
$24K |
| 92083 |
|
467 |
454 |
$23K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
712 |
699 |
$20K |
| 92286 |
|
371 |
369 |
$16K |
| 92285 |
|
712 |
695 |
$14K |
| 76512 |
|
250 |
127 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
194 |
187 |
$5K |
| 92060 |
|
251 |
248 |
$3K |
| 92020 |
|
86 |
78 |
$991.85 |
| 92025 |
|
47 |
40 |
$776.10 |
| 76514 |
|
77 |
76 |
$526.39 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
25 |
25 |
$235.00 |