| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
822 |
813 |
$32K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
569 |
562 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
551 |
547 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
464 |
460 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
37 |
37 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
202 |
202 |
$132.72 |
| 92015 |
Determination of refractive state |
598 |
592 |
$0.00 |