| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
507 |
468 |
$41K |
| 92250 |
|
222 |
220 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
202 |
199 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
54 |
54 |
$3K |
| V2750 |
Anti-reflective coating, per lens |
66 |
28 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
60 |
48 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
51 |
39 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
118 |
105 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
59 |
40 |
$1K |
| 92060 |
|
27 |
27 |
$942.29 |
| 92015 |
Determination of refractive state |
51 |
51 |
$890.56 |