| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
121 |
116 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
70 |
66 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
36 |
34 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
31 |
27 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
43 |
43 |
$964.40 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$715.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$152.50 |
| 92015 |
Determination of refractive state |
19 |
19 |
$0.00 |