| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
85 |
84 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
75 |
74 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$697.16 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
14 |
14 |
$660.07 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$637.96 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$620.40 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$288.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
40 |
40 |
$240.00 |