| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
812 |
756 |
$20K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
310 |
290 |
$12K |
| 92370 |
|
836 |
776 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
697 |
643 |
$10K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
137 |
135 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
418 |
385 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
267 |
257 |
$2K |
| 92341 |
|
75 |
75 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
76 |
76 |
$842.57 |
| 92283 |
|
92 |
92 |
$270.99 |