| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
99 |
96 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
63 |
61 |
$1K |
| V2020 |
Frames, purchases |
78 |
76 |
$511.55 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
67 |
65 |
$479.64 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
39 |
37 |
$0.00 |
| 92015 |
Determination of refractive state |
161 |
157 |
$0.00 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
13 |
13 |
$0.00 |