| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
983 |
947 |
$36K |
| V2020 |
Frames, purchases |
1,042 |
999 |
$28K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
625 |
590 |
$26K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
380 |
375 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
405 |
403 |
$17K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
513 |
485 |
$11K |
| 92015 |
Determination of refractive state |
864 |
853 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
593 |
558 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
15 |
15 |
$666.75 |
| V2025 |
Deluxe frame |
16 |
16 |
$640.00 |
| 92250 |
|
64 |
64 |
$0.00 |