| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
641 |
616 |
$29K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
873 |
660 |
$12K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
321 |
317 |
$10K |
| 92012 |
|
254 |
245 |
$9K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
232 |
227 |
$7K |
| 92004 |
|
83 |
83 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
101 |
95 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
72 |
53 |
$3K |
| 92002 |
|
42 |
42 |
$1K |
| 92014 |
|
12 |
12 |
$587.91 |