| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
122 |
119 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
26 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
27 |
27 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
18 |
17 |
$734.30 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
34 |
34 |
$699.96 |
| 92015 |
Determination of refractive state |
32 |
32 |
$469.44 |