| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,501 |
1,487 |
$78K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
927 |
920 |
$30K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
633 |
631 |
$19K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
413 |
413 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
440 |
438 |
$8K |
| V2760 |
Scratch resistant coating, per lens |
192 |
192 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
15 |
$690.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
50 |
50 |
$603.25 |
| 92015 |
Determination of refractive state |
190 |
185 |
$579.15 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
20 |
18 |
$70.00 |