| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,712 |
1,546 |
$44K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,052 |
958 |
$29K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
299 |
292 |
$28K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
288 |
265 |
$18K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
538 |
496 |
$13K |
| 92015 |
Determination of refractive state |
600 |
559 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
82 |
70 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
58 |
53 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
16 |
16 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$695.58 |
| V2025 |
Deluxe frame |
17 |
17 |
$675.51 |