| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,696 |
2,599 |
$64K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,425 |
2,343 |
$56K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
956 |
926 |
$47K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
632 |
613 |
$30K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
144 |
137 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
100 |
98 |
$8K |
| 92015 |
Determination of refractive state |
343 |
332 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
13 |
$1K |
| V2025 |
Deluxe frame |
28 |
27 |
$914.90 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
276 |
268 |
$652.00 |