| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,224 |
1,189 |
$42K |
| V2020 |
Frames, purchases |
910 |
882 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
406 |
405 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
385 |
379 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
809 |
786 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
109 |
109 |
$5K |
| V2025 |
Deluxe frame |
30 |
30 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
14 |
14 |
$635.00 |
| 92015 |
Determination of refractive state |
1,170 |
1,145 |
$0.00 |