| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,218 |
1,216 |
$32K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
215 |
215 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
197 |
180 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
14 |
14 |
$607.75 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
26 |
$495.25 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
47 |
38 |
$468.01 |