| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,392 |
2,303 |
$85K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,693 |
2,636 |
$80K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,058 |
1,976 |
$69K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,126 |
1,110 |
$34K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
387 |
386 |
$14K |
| V2760 |
Scratch resistant coating, per lens |
891 |
859 |
$12K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
361 |
356 |
$11K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
175 |
174 |
$8K |
| S0500 |
Disposable contact lens, per lens |
43 |
43 |
$3K |
| 92250 |
|
34 |
34 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
13 |
12 |
$438.00 |
| 92133 |
|
12 |
12 |
$334.70 |