| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,235 |
1,221 |
$55K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
691 |
683 |
$24K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
731 |
721 |
$18K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
609 |
601 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
90 |
90 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
93 |
93 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
87 |
86 |
$3K |
| V2750 |
Anti-reflective coating, per lens |
337 |
336 |
$88.48 |
| 92015 |
Determination of refractive state |
882 |
876 |
$4.95 |
| V2744 |
Tint, photochromatic, per lens |
12 |
12 |
$0.00 |