| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
187 |
187 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
165 |
84 |
$455.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
74 |
74 |
$399.08 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$360.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
40 |
20 |
$130.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
74 |
74 |
$64.00 |
| V2750 |
Anti-reflective coating, per lens |
36 |
36 |
$0.00 |
| 92015 |
Determination of refractive state |
100 |
70 |
$0.00 |