| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
530 |
529 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
260 |
129 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
120 |
120 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
73 |
73 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
45 |
45 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
17 |
17 |
$680.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19 |
12 |
$673.38 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
15 |
$393.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,077 |
547 |
$120.00 |