| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
742 |
737 |
$23K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
420 |
419 |
$20K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
558 |
553 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
226 |
224 |
$2K |
| 92015 |
Determination of refractive state |
184 |
184 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
14 |
$984.62 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
62 |
62 |
$706.56 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$0.00 |