| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
844 |
827 |
$53K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
449 |
444 |
$37K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
826 |
807 |
$23K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
247 |
246 |
$22K |
| V2020 |
Frames, purchases |
845 |
828 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
299 |
295 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
26 |
$427.54 |
| 92015 |
Determination of refractive state |
14 |
14 |
$260.00 |