| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
77 |
64 |
$2K |
| V2020 |
Frames, purchases |
134 |
114 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
90 |
76 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
18 |
18 |
$900.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
27 |
22 |
$587.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
25 |
$580.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
21 |
$568.00 |