| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
79 |
78 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
54 |
53 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
29 |
29 |
$721.52 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
16 |
16 |
$560.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
13 |
13 |
$390.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
15 |
$96.00 |
| 92015 |
Determination of refractive state |
23 |
22 |
$0.00 |