| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
6,217 |
6,179 |
$141K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,894 |
2,887 |
$97K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,521 |
2,515 |
$85K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,083 |
5,067 |
$76K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,424 |
3,367 |
$38K |
| 92341 |
|
753 |
753 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,241 |
1,227 |
$11K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
593 |
567 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
133 |
132 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$207.10 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$19.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
344 |
333 |
$0.00 |