| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,040 |
556 |
$20K |
| 76512 |
|
263 |
263 |
$16K |
| 92250 |
|
284 |
283 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
308 |
305 |
$10K |
| V2020 |
Frames, purchases |
750 |
722 |
$9K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
90 |
90 |
$6K |
| 92285 |
|
221 |
221 |
$6K |
| 92133 |
|
155 |
155 |
$4K |
| 92083 |
|
12 |
12 |
$558.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
63 |
39 |
$134.00 |