| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,733 |
1,730 |
$103K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,002 |
1,002 |
$60K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
123 |
123 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
78 |
78 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
65 |
65 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
54 |
52 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$985.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
442 |
442 |
$722.00 |
| 92015 |
Determination of refractive state |
41 |
41 |
$0.00 |