| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
530 |
287 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
369 |
358 |
$9K |
| V2020 |
Frames, purchases |
427 |
423 |
$5K |
| 92250 |
|
162 |
126 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
38 |
38 |
$1K |
| 92286 |
|
78 |
40 |
$696.06 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
33 |
33 |
$200.00 |
| 92015 |
Determination of refractive state |
83 |
83 |
$0.00 |