| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,026 |
1,439 |
$111K |
| V2020 |
Frames, purchases |
2,408 |
1,771 |
$110K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,243 |
1,218 |
$56K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,143 |
1,125 |
$51K |
| 92250 |
|
169 |
164 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,378 |
711 |
$3K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
18 |
13 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
125 |
124 |
$870.09 |