| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,000 |
3,921 |
$176K |
| V2020 |
Frames, purchases |
2,380 |
2,332 |
$73K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,435 |
2,382 |
$71K |
| S0500 |
Disposable contact lens, per lens |
471 |
471 |
$63K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,202 |
2,152 |
$14K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
94 |
94 |
$4K |
| V2025 |
Deluxe frame |
45 |
42 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
20 |
19 |
$124.12 |
| 92015 |
Determination of refractive state |
3,310 |
3,245 |
$0.00 |
| 99199 |
Unlisted special service, procedure or report |
294 |
294 |
$0.00 |
| 92250 |
|
52 |
52 |
$0.00 |
| 2023F |
|
22 |
17 |
$0.00 |