| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
218 |
212 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
157 |
156 |
$6K |
| V2020 |
Frames, purchases |
291 |
285 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
153 |
153 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
147 |
142 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$644.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$156.00 |
| 92015 |
Determination of refractive state |
387 |
384 |
$0.00 |