| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
203 |
200 |
$11K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
337 |
331 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
174 |
174 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
91 |
88 |
$2K |
| V2020 |
Frames, purchases |
27 |
27 |
$430.82 |
| 92015 |
Determination of refractive state |
602 |
592 |
$0.00 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
15 |
15 |
$0.00 |