| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
763 |
763 |
$10K |
| V2020 |
Frames, purchases |
1,305 |
1,299 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
612 |
306 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
515 |
286 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
83 |
81 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
19 |
$519.28 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
280 |
140 |
$0.00 |
| V2755 |
U-v lens, per lens |
104 |
52 |
$0.00 |