| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,027 |
1,021 |
$63K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
556 |
553 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
320 |
319 |
$11K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
313 |
313 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
448 |
446 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
119 |
118 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
82 |
81 |
$625.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$251.80 |
| V2750 |
Anti-reflective coating, per lens |
26 |
26 |
$9.24 |
| 92250 |
|
13 |
13 |
$0.00 |
| 92015 |
Determination of refractive state |
434 |
433 |
$0.00 |