| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,364 |
2,289 |
$63K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,135 |
1,094 |
$45K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,124 |
1,117 |
$45K |
| V2020 |
Frames, purchases |
2,203 |
2,131 |
$44K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,269 |
2,195 |
$14K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
72 |
72 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
34 |
34 |
$2K |
| V2025 |
Deluxe frame |
13 |
13 |
$195.00 |
| 92015 |
Determination of refractive state |
2,523 |
2,468 |
$0.00 |