| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,255 |
1,249 |
$40K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
316 |
316 |
$15K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
137 |
137 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
541 |
384 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
24 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
20 |
12 |
$129.54 |