| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
388 |
388 |
$22K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
171 |
171 |
$8K |
| V2025 |
Deluxe frame |
262 |
262 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
84 |
83 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
52 |
52 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$540.00 |
| V2760 |
Scratch resistant coating, per lens |
45 |
45 |
$460.00 |
| V2020 |
Frames, purchases |
28 |
28 |
$379.96 |
| 92015 |
Determination of refractive state |
129 |
129 |
$132.56 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
16 |
$35.00 |