| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
138 |
134 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
69 |
68 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
65 |
65 |
$1K |
| V2025 |
Deluxe frame |
15 |
15 |
$811.50 |
| V2020 |
Frames, purchases |
30 |
29 |
$513.48 |
| V2799 |
Vision item or service, miscellaneous |
13 |
12 |
$107.92 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
31 |
30 |
$0.00 |
| 92015 |
Determination of refractive state |
323 |
312 |
$0.00 |