| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
555 |
185 |
$11K |
| V2020 |
Frames, purchases |
719 |
343 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
20 |
20 |
$900.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
20 |
20 |
$900.00 |
| 92015 |
Determination of refractive state |
80 |
80 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
44 |
22 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
83 |
60 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
55 |
40 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
13 |
$0.00 |