| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
560 |
278 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
165 |
164 |
$11K |
| 92083 |
|
204 |
202 |
$9K |
| 92250 |
|
209 |
207 |
$8K |
| 92286 |
|
117 |
116 |
$8K |
| 92285 |
|
105 |
104 |
$6K |
| V2020 |
Frames, purchases |
325 |
314 |
$4K |
| 76512 |
|
70 |
40 |
$3K |
| 68761 |
|
24 |
12 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
29 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
14 |
12 |
$546.00 |
| 92060 |
|
13 |
13 |
$396.42 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
472 |
231 |
$340.00 |
| 92020 |
|
12 |
12 |
$147.12 |