| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
469 |
426 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
235 |
109 |
$6K |
| 92250 |
|
83 |
79 |
$4K |
| 92015 |
Determination of refractive state |
302 |
300 |
$3K |
| V2750 |
Anti-reflective coating, per lens |
123 |
60 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
37 |
37 |
$2K |
| 99215 |
Prolong outpt/office vis |
17 |
17 |
$1K |
| 92286 |
|
26 |
25 |
$881.10 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
18 |
$803.22 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
13 |
13 |
$390.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
240 |
100 |
$260.00 |