| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92341 |
|
699 |
699 |
$16K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
691 |
691 |
$14K |
| V2020 |
Frames, purchases |
442 |
442 |
$10K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
164 |
164 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
56 |
42 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
24 |
24 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
41 |
27 |
$753.29 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
14 |
14 |
$514.78 |
| 92015 |
Determination of refractive state |
131 |
131 |
$377.06 |