| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
539 |
537 |
$13K |
| V2020 |
Frames, purchases |
694 |
691 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
263 |
263 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
194 |
194 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
546 |
543 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
38 |
37 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
31 |
31 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$240.00 |
| V2750 |
Anti-reflective coating, per lens |
72 |
71 |
$0.00 |
| 92015 |
Determination of refractive state |
482 |
481 |
$0.00 |
| V2755 |
U-v lens, per lens |
12 |
12 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
13 |
13 |
$0.00 |