| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,878 |
4,862 |
$148K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,886 |
1,885 |
$90K |
| 92340 |
|
4,466 |
4,453 |
$88K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,170 |
1,165 |
$58K |
| 92004 |
|
798 |
798 |
$57K |
| 92014 |
|
1,315 |
1,313 |
$56K |
| 92341 |
|
1,777 |
1,774 |
$40K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,590 |
3,008 |
$38K |
| 92250 |
|
1,835 |
1,831 |
$29K |
| 92015 |
|
2,586 |
2,583 |
$29K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,011 |
675 |
$10K |
| 92012 |
|
75 |
67 |
$3K |
| 99214 |
|
12 |
12 |
$721.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
26 |
$528.00 |
| 92133 |
|
12 |
12 |
$190.80 |
| V2756 |
Eye glass case |
783 |
780 |
$170.64 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
17 |
12 |
$169.07 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$72.00 |