| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
214 |
214 |
$13K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
291 |
290 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
183 |
183 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
26 |
$501.00 |
| V2760 |
Scratch resistant coating, per lens |
48 |
48 |
$488.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
13 |
$97.35 |