| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,094 |
2,026 |
$78K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
906 |
891 |
$68K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
862 |
850 |
$36K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
353 |
350 |
$35K |
| V2020 |
Frames, purchases |
1,323 |
1,283 |
$35K |
| V2025 |
Deluxe frame |
691 |
681 |
$24K |
| 92015 |
Determination of refractive state |
1,444 |
1,420 |
$18K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
404 |
399 |
$17K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
146 |
131 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
304 |
297 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$540.54 |