| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
599 |
599 |
$38K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
476 |
476 |
$14K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
327 |
327 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
212 |
212 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
268 |
268 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
160 |
160 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
37 |
37 |
$455.00 |
| 92015 |
Determination of refractive state |
296 |
296 |
$0.00 |