| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,045 |
1,515 |
$164K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
390 |
385 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
723 |
504 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
69 |
55 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
69 |
69 |
$3K |
| V2500 |
Contact lens, pmma, spherical, per lens |
42 |
30 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
56 |
56 |
$2K |
| 92015 |
Determination of refractive state |
13 |
13 |
$58.50 |