| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,311 |
1,308 |
$97K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
520 |
520 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
358 |
358 |
$8K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
241 |
241 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
157 |
155 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
208 |
207 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$1K |
| 92015 |
Determination of refractive state |
347 |
347 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
25 |
25 |
$0.00 |