| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
88 |
88 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
34 |
34 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
15 |
15 |
$675.00 |
| V2020 |
Frames, purchases |
67 |
67 |
$588.96 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$585.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$585.00 |