| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,040 |
5,003 |
$123K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,000 |
1,989 |
$103K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
934 |
932 |
$82K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,452 |
3,438 |
$65K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
397 |
396 |
$41K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
788 |
784 |
$38K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
969 |
962 |
$18K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
51 |
51 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$735.72 |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
29 |
29 |
$572.00 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
20 |
19 |
$440.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$200.00 |