| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
862 |
847 |
$18K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
357 |
355 |
$12K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
153 |
152 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
76 |
75 |
$8K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
98 |
98 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
189 |
189 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
17 |
17 |
$2K |
| 92015 |
Determination of refractive state |
120 |
120 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
30 |
30 |
$805.36 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$327.68 |