| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
795 |
502 |
$42K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
785 |
497 |
$35K |
| V2020 |
Frames, purchases |
848 |
523 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
154 |
150 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
86 |
86 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
29 |
28 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$560.00 |