| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
378 |
366 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
177 |
173 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
92 |
88 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
14 |
12 |
$140.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
24 |
$104.00 |
| 92015 |
Determination of refractive state |
254 |
250 |
$31.50 |