| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
97 |
97 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
41 |
41 |
$4K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
42 |
42 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$2K |
| 92015 |
Determination of refractive state |
73 |
72 |
$1K |
| V2025 |
Deluxe frame |
29 |
29 |
$585.00 |
| V2020 |
Frames, purchases |
35 |
35 |
$310.96 |
| V2760 |
Scratch resistant coating, per lens |
25 |
25 |
$240.00 |