| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,589 |
1,567 |
$65K |
| 92015 |
|
2,395 |
2,347 |
$42K |
| 92004 |
|
853 |
831 |
$40K |
| V2025 |
Deluxe frame |
681 |
667 |
$30K |
| 92340 |
|
699 |
682 |
$20K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
207 |
201 |
$9K |
| V2020 |
Frames, purchases |
470 |
436 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
132 |
128 |
$6K |
| 92341 |
|
210 |
192 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
338 |
314 |
$4K |
| 99213 |
|
115 |
98 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
416 |
401 |
$4K |
| 83861 |
|
80 |
56 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
63 |
53 |
$926.94 |
| 92012 |
|
27 |
26 |
$794.08 |
| 83516 |
|
52 |
39 |
$615.32 |
| 99214 |
|
13 |
12 |
$551.92 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
26 |
$259.64 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
17 |
17 |
$136.26 |