| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
547 |
527 |
$10K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
73 |
72 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
76 |
76 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
98 |
95 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
203 |
200 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
41 |
41 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$360.00 |
| 92015 |
Determination of refractive state |
13 |
13 |
$0.00 |