| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,013 |
1,009 |
$95K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
825 |
825 |
$25K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
425 |
424 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
209 |
209 |
$2K |
| 92310 |
|
25 |
25 |
$920.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
37 |
37 |
$740.00 |
| V2760 |
Scratch resistant coating, per lens |
37 |
37 |
$370.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
37 |
37 |
$160.00 |
| 92015 |
Determination of refractive state |
387 |
387 |
$135.00 |