| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
306 |
292 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
140 |
129 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
174 |
162 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
89 |
83 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
14 |
14 |
$700.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
16 |
16 |
$418.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
16 |
$148.00 |