| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
158 |
147 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
132 |
130 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
63 |
63 |
$3K |
| V2025 |
Deluxe frame |
121 |
116 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
18 |
15 |
$810.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$361.08 |