| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
900 |
450 |
$18K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
370 |
370 |
$15K |
| V2020 |
Frames, purchases |
1,043 |
1,041 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
115 |
115 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
114 |
114 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
30 |
30 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
97 |
79 |
$739.44 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
14 |
14 |
$546.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,851 |
939 |
$0.00 |