| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
652 |
644 |
$54K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
779 |
776 |
$23K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
428 |
426 |
$13K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
191 |
191 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
12 |
$390.83 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$252.00 |