| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
621 |
340 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
239 |
236 |
$10K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
184 |
183 |
$6K |
| V2020 |
Frames, purchases |
404 |
401 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
55 |
55 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
663 |
364 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$744.00 |
| 92015 |
Determination of refractive state |
332 |
330 |
$45.00 |