| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
799 |
746 |
$65K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
829 |
810 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
218 |
212 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
66 |
65 |
$3K |
| 92015 |
Determination of refractive state |
259 |
256 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
28 |
$913.76 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
14 |
14 |
$845.00 |
| 92310 |
|
15 |
15 |
$490.00 |