| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,859 |
1,830 |
$39K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
243 |
243 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
768 |
375 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
411 |
254 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
219 |
212 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,274 |
1,185 |
$4K |
| 92250 |
|
133 |
133 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
16 |
16 |
$640.00 |
| 92225 |
|
13 |
13 |
$203.97 |