| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
594 |
583 |
$38K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
161 |
157 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
209 |
206 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
40 |
40 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
28 |
28 |
$840.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
127 |
122 |
$685.76 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$490.00 |
| 92015 |
Determination of refractive state |
623 |
619 |
$200.92 |
| V2750 |
Anti-reflective coating, per lens |
42 |
42 |
$44.24 |