| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,499 |
1,489 |
$114K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
789 |
788 |
$24K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
411 |
411 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
486 |
483 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
195 |
193 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
240 |
238 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
92 |
92 |
$3K |
| 92310 |
|
24 |
24 |
$911.80 |
| V2750 |
Anti-reflective coating, per lens |
26 |
26 |
$88.48 |
| 92015 |
Determination of refractive state |
470 |
469 |
$0.00 |