| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
735 |
734 |
$8K |
| 99213 |
|
108 |
100 |
$3K |
| 92012 |
|
50 |
50 |
$2K |
| 92340 |
|
135 |
135 |
$2K |
| 92004 |
|
178 |
178 |
$2K |
| 92015 |
|
489 |
489 |
$1K |
| V2020 |
Frames, purchases |
682 |
679 |
$510.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
109 |
57 |
$84.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
237 |
137 |
$33.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$23.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
88 |
53 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
64 |
64 |
$0.00 |