| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
1,117 |
1,112 |
$55K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
179 |
178 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
143 |
143 |
$10K |
| V2111 |
Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens |
269 |
265 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
370 |
367 |
$5K |
| V2020 |
Frames, purchases |
560 |
557 |
$4K |
| 76512 |
|
12 |
12 |
$3K |
| V2211 |
Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens |
78 |
77 |
$3K |
| 92285 |
|
179 |
177 |
$2K |
| 92015 |
Determination of refractive state |
123 |
123 |
$1K |
| 92341 |
|
75 |
74 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
135 |
134 |
$1K |
| 92025 |
|
47 |
47 |
$975.04 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
59 |
59 |
$846.00 |