| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,850 |
666 |
$98K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,223 |
455 |
$55K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,188 |
479 |
$53K |
| V2025 |
Deluxe frame |
1,627 |
586 |
$18K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
91 |
91 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
85 |
85 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
28 |
$0.00 |