| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
569 |
566 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
441 |
441 |
$17K |
| V2020 |
Frames, purchases |
419 |
416 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
52 |
50 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
330 |
328 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
20 |
20 |
$905.00 |
| 92015 |
Determination of refractive state |
725 |
715 |
$16.44 |