| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
886 |
812 |
$61K |
| V2020 |
Frames, purchases |
1,129 |
1,064 |
$27K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
469 |
460 |
$19K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
250 |
250 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
55 |
53 |
$2K |
| V2025 |
Deluxe frame |
127 |
124 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
49 |
49 |
$1K |
| 92015 |
Determination of refractive state |
16 |
16 |
$600.00 |
| V2799 |
Vision item or service, miscellaneous |
106 |
105 |
$100.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
24 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
17 |
17 |
$0.00 |