| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
300 |
178 |
$18K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
199 |
128 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
143 |
127 |
$6K |
| V2025 |
Deluxe frame |
334 |
206 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
17 |
15 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
54 |
53 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
14 |
13 |
$630.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
31 |
30 |
$0.00 |