| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
262 |
262 |
$5K |
| V2020 |
Frames, purchases |
264 |
264 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
89 |
89 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
86 |
86 |
$724.74 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$561.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
42 |
42 |
$331.20 |
| V2756 |
Eye glass case |
199 |
199 |
$53.73 |