| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
579 |
577 |
$42K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
328 |
328 |
$15K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
136 |
136 |
$6K |
| V2020 |
Frames, purchases |
373 |
371 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
68 |
63 |
$3K |
| V2025 |
Deluxe frame |
122 |
122 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$1K |