| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
130 |
129 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
95 |
95 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
39 |
38 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
26 |
25 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
96 |
72 |
$574.47 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
12 |
$91.20 |
| V2756 |
Eye glass case |
110 |
110 |
$11.61 |