| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,209 |
1,142 |
$14K |
| V2020 |
Frames, purchases |
1,122 |
1,086 |
$14K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
279 |
274 |
$11K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
156 |
155 |
$7K |
| V2025 |
Deluxe frame |
29 |
29 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
45 |
40 |
$181.25 |
| 92015 |
Determination of refractive state |
49 |
47 |
$0.00 |