| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
132 |
128 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
75 |
73 |
$4K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
75 |
74 |
$4K |
| V2020 |
Frames, purchases |
42 |
42 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$633.08 |
| 92015 |
Determination of refractive state |
60 |
57 |
$579.53 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
30 |
$180.00 |