| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
553 |
496 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,025 |
1,000 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
405 |
397 |
$390.00 |
| 92015 |
Determination of refractive state |
899 |
877 |
$30.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,512 |
703 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,010 |
940 |
$0.00 |
| V2020 |
Frames, purchases |
1,087 |
1,022 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
198 |
96 |
$0.00 |