| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
926 |
909 |
$54K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
696 |
667 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
248 |
239 |
$7K |
| 92014 |
|
12 |
12 |
$503.48 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$360.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$309.24 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$235.52 |