| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
156 |
156 |
$7K |
| V2020 |
Frames, purchases |
372 |
365 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
54 |
54 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
102 |
100 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
46 |
46 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
16 |
14 |
$525.00 |
| 92015 |
Determination of refractive state |
27 |
27 |
$386.82 |