| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
111 |
108 |
$5K |
| V2020 |
Frames, purchases |
143 |
142 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
103 |
102 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
46 |
46 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
63 |
62 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$182.00 |