| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
135 |
135 |
$10K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
79 |
79 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
78 |
78 |
$4K |
| V2020 |
Frames, purchases |
137 |
137 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
19 |
19 |
$855.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
19 |
19 |
$855.00 |