| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
460 |
363 |
$25K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
110 |
94 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
32 |
32 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$942.11 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
27 |
27 |
$886.68 |
| V2760 |
Scratch resistant coating, per lens |
12 |
12 |
$0.00 |