| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,926 |
1,033 |
$36K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
775 |
775 |
$29K |
| V2020 |
Frames, purchases |
1,601 |
1,598 |
$19K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
59 |
59 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
150 |
76 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,561 |
793 |
$863.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$360.00 |