| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,644 |
1,632 |
$118K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,173 |
1,171 |
$35K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,178 |
1,029 |
$29K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
366 |
357 |
$14K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
222 |
222 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$241.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$240.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
13 |
$100.00 |