| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
640 |
630 |
$22K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
304 |
301 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
426 |
422 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
60 |
60 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
335 |
332 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$360.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$360.00 |
| 92015 |
Determination of refractive state |
251 |
251 |
$4.95 |
| V2750 |
Anti-reflective coating, per lens |
115 |
114 |
$0.00 |