| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,419 |
1,388 |
$34K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
716 |
708 |
$33K |
| V2020 |
Frames, purchases |
1,448 |
1,400 |
$27K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
525 |
522 |
$24K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
206 |
205 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
35 |
34 |
$825.08 |
| V2750 |
Anti-reflective coating, per lens |
15 |
15 |
$278.60 |
| 92015 |
Determination of refractive state |
72 |
72 |
$225.58 |