| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,326 |
2,316 |
$98K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,274 |
1,656 |
$70K |
| V2020 |
Frames, purchases |
2,725 |
2,672 |
$35K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
604 |
298 |
$17K |
| 92012 |
|
563 |
560 |
$15K |
| 92341 |
|
568 |
564 |
$11K |
| 92340 |
|
571 |
570 |
$9K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
100 |
100 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
152 |
76 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,210 |
2,553 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
44 |
44 |
$2K |
| 92015 |
|
1,080 |
1,076 |
$167.62 |
| 2022F |
|
12 |
12 |
$0.00 |