| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,337 |
2,219 |
$58K |
| V2020 |
Frames, purchases |
3,565 |
3,032 |
$41K |
| 92004 |
|
1,282 |
1,229 |
$34K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,142 |
1,684 |
$27K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
406 |
406 |
$20K |
| 92340 |
|
393 |
389 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,967 |
1,422 |
$9K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
118 |
118 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
296 |
248 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
507 |
384 |
$6K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
67 |
54 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
153 |
116 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$280.00 |
| 92015 |
|
2,398 |
2,227 |
$0.00 |