| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
710 |
684 |
$21K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
342 |
307 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
765 |
709 |
$16K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
169 |
165 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
95 |
83 |
$4K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
66 |
62 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
276 |
273 |
$1K |
| 92015 |
Determination of refractive state |
646 |
587 |
$979.34 |
| V2025 |
Deluxe frame |
79 |
61 |
$918.00 |