| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
141 |
138 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
62 |
62 |
$705.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
13 |
13 |
$650.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
49 |
49 |
$520.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
22 |
22 |
$117.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$90.00 |
| 92015 |
Determination of refractive state |
96 |
95 |
$0.00 |