| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,120 |
1,059 |
$36K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
668 |
668 |
$22K |
| V2020 |
Frames, purchases |
1,715 |
1,712 |
$18K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
240 |
239 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
116 |
57 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
33 |
33 |
$920.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
240 |
120 |
$300.00 |
| 92002 |
|
25 |
25 |
$280.00 |