| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
788 |
785 |
$58K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
348 |
348 |
$16K |
| V2020 |
Frames, purchases |
840 |
837 |
$11K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
89 |
89 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
28 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
16 |
$656.73 |
| 92015 |
Determination of refractive state |
13 |
12 |
$169.56 |