| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
127 |
125 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
254 |
251 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
89 |
89 |
$5K |
| V2020 |
Frames, purchases |
349 |
347 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
79 |
78 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
13 |
$650.00 |
| 92341 |
|
25 |
25 |
$507.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
170 |
169 |
$174.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
146 |
146 |
$112.52 |