| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,489 |
3,455 |
$104K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,090 |
2,085 |
$97K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,310 |
1,308 |
$64K |
| 92340 |
|
2,920 |
2,905 |
$55K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,266 |
2,201 |
$31K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
39 |
$566.08 |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
14 |
14 |
$430.57 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
36 |
36 |
$330.06 |
| 92341 |
|
12 |
12 |
$302.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$181.39 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
137 |
135 |
$0.00 |