| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,041 |
1,014 |
$22K |
| V2020 |
Frames, purchases |
1,273 |
1,242 |
$22K |
| 92015 |
Determination of refractive state |
599 |
567 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
580 |
562 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
45 |
40 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
41 |
37 |
$2K |
| 92310 |
|
27 |
26 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
17 |
15 |
$737.85 |