| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
319 |
314 |
$23K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
273 |
273 |
$12K |
| V2020 |
Frames, purchases |
178 |
176 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
31 |
31 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
21 |
21 |
$945.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
18 |
$810.00 |
| V2025 |
Deluxe frame |
26 |
26 |
$717.76 |