| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,057 |
1,045 |
$72K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,132 |
2,126 |
$64K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
486 |
480 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
356 |
355 |
$5K |
| 92310 |
|
55 |
55 |
$2K |
| V2599 |
Contact lens, other type |
28 |
27 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
14 |
13 |
$560.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
13 |
$438.50 |