| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,541 |
2,483 |
$90K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,626 |
2,589 |
$78K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,139 |
2,091 |
$72K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,208 |
1,181 |
$36K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
514 |
512 |
$16K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
503 |
502 |
$15K |
| V2760 |
Scratch resistant coating, per lens |
898 |
888 |
$12K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
235 |
234 |
$11K |
| S0500 |
Disposable contact lens, per lens |
48 |
48 |
$3K |
| 92250 |
|
12 |
12 |
$652.57 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15 |
12 |
$343.20 |
| 92015 |
Determination of refractive state |
12 |
12 |
$14.85 |