| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
327 |
327 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
375 |
188 |
$8K |
| V2020 |
Frames, purchases |
833 |
832 |
$7K |
| 92004 |
|
180 |
180 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
458 |
303 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
15 |
$857.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
309 |
159 |
$0.00 |