| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
626 |
626 |
$18K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
274 |
274 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
197 |
197 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
215 |
215 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
26 |
26 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
15 |
15 |
$1K |
| 92015 |
Determination of refractive state |
44 |
44 |
$462.89 |