| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
828 |
791 |
$31K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
666 |
665 |
$20K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
627 |
498 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
84 |
79 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
114 |
87 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
63 |
41 |
$2K |
| 92015 |
Determination of refractive state |
36 |
36 |
$163.95 |