| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,583 |
1,553 |
$64K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,501 |
948 |
$45K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,009 |
998 |
$45K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
314 |
313 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
63 |
63 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
315 |
191 |
$3K |
| 92015 |
Determination of refractive state |
1,375 |
1,366 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$646.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$390.00 |
| V2760 |
Scratch resistant coating, per lens |
37 |
30 |
$354.00 |