| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,612 |
2,024 |
$120K |
| V2020 |
Frames, purchases |
2,963 |
2,310 |
$91K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,419 |
1,003 |
$89K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
178 |
114 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
560 |
426 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
56 |
56 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
12 |
$1K |
| 92015 |
Determination of refractive state |
97 |
91 |
$873.00 |