| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,056 |
2,033 |
$128K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,990 |
1,988 |
$60K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,574 |
1,549 |
$49K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
658 |
658 |
$20K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
657 |
616 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
404 |
394 |
$9K |
| 92250 |
|
171 |
168 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
120 |
119 |
$5K |
| 92133 |
|
134 |
133 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
26 |
$1K |
| S0500 |
Disposable contact lens, per lens |
13 |
13 |
$815.99 |
| 92083 |
|
12 |
12 |
$812.68 |