| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,549 |
1,515 |
$85K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
934 |
909 |
$28K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
688 |
676 |
$19K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
374 |
369 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
154 |
151 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
394 |
390 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
189 |
185 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
65 |
63 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
168 |
129 |
$1K |
| 92015 |
Determination of refractive state |
684 |
663 |
$882.00 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$44.24 |