| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,726 |
6,706 |
$157K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
3,254 |
3,254 |
$113K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,989 |
2,988 |
$104K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
6,008 |
5,988 |
$90K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,164 |
4,153 |
$50K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,151 |
1,148 |
$13K |
| 92341 |
|
702 |
701 |
$12K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
516 |
512 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
263 |
263 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
65 |
65 |
$772.90 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
331 |
331 |
$0.00 |