| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,556 |
753 |
$30K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
675 |
675 |
$26K |
| V2020 |
Frames, purchases |
1,794 |
1,719 |
$19K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
374 |
374 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
630 |
310 |
$13K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
46 |
46 |
$2K |
| 92002 |
|
30 |
30 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,515 |
1,706 |
$0.00 |