| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,005 |
3,642 |
$79K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,480 |
1,468 |
$77K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,564 |
1,361 |
$61K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,311 |
1,279 |
$57K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
740 |
653 |
$39K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,200 |
1,058 |
$38K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
558 |
535 |
$24K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
139 |
128 |
$10K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
185 |
185 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
47 |
41 |
$2K |
| V2025 |
Deluxe frame |
180 |
180 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$678.42 |