| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
865 |
827 |
$19K |
| V2020 |
Frames, purchases |
854 |
839 |
$14K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
519 |
337 |
$13K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
368 |
318 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
288 |
283 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
38 |
38 |
$77.00 |
| 92015 |
Determination of refractive state |
144 |
132 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
108 |
107 |
$0.00 |