| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
558 |
550 |
$20K |
| V2020 |
Frames, purchases |
691 |
669 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
206 |
203 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
634 |
624 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
277 |
261 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
434 |
425 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
66 |
66 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
102 |
101 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
504 |
491 |
$3K |
| 92015 |
Determination of refractive state |
461 |
443 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
176 |
171 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
51 |
51 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
14 |
13 |
$44.01 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
16 |
13 |
$0.00 |