| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,007 |
1,006 |
$41K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,416 |
693 |
$29K |
| V2020 |
Frames, purchases |
1,746 |
1,719 |
$25K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
315 |
163 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
162 |
162 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
39 |
39 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,189 |
1,572 |
$970.00 |