| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
405 |
346 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
161 |
154 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
181 |
169 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
52 |
34 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
81 |
53 |
$955.50 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
66 |
66 |
$805.00 |
| 92002 |
|
24 |
24 |
$570.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
26 |
21 |
$450.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
58 |
34 |
$286.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
38 |
18 |
$150.00 |