| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
106 |
104 |
$3K |
| V2020 |
Frames, purchases |
129 |
128 |
$100.30 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
90 |
88 |
$22.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
17 |
17 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
37 |
37 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
30 |
$0.00 |
| 92015 |
|
85 |
84 |
$0.00 |