| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
399 |
387 |
$18K |
| V2020 |
Frames, purchases |
907 |
881 |
$18K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
345 |
331 |
$13K |
| 92083 |
|
123 |
119 |
$6K |
| 92285 |
|
190 |
187 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
110 |
108 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
76 |
62 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
12 |
$315.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
12 |
$130.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
14 |
$82.16 |
| 92341 |
|
13 |
12 |
$55.00 |
| 92015 |
Determination of refractive state |
194 |
185 |
$0.00 |