| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
362 |
336 |
$21K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
347 |
337 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
359 |
334 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
72 |
52 |
$385.75 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
31 |
29 |
$0.00 |
| 92015 |
Determination of refractive state |
18 |
18 |
$0.00 |