| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
290 |
289 |
$18K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
315 |
315 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
293 |
293 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
403 |
400 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
99 |
99 |
$7K |
| 92015 |
Determination of refractive state |
172 |
171 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
92 |
92 |
$4K |
| V2020 |
Frames, purchases |
183 |
180 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
78 |
76 |
$1K |