| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
456 |
450 |
$26K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
307 |
306 |
$20K |
| V2020 |
Frames, purchases |
764 |
734 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
753 |
738 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
673 |
655 |
$10K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
213 |
210 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
118 |
116 |
$9K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
71 |
70 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
48 |
46 |
$666.33 |
| 92015 |
Determination of refractive state |
631 |
623 |
$219.30 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
12 |
$158.35 |