| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,574 |
1,570 |
$50K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
370 |
370 |
$18K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
855 |
855 |
$17K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
247 |
247 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
413 |
412 |
$6K |
| 92341 |
|
166 |
166 |
$4K |
| 92370 |
|
25 |
25 |
$435.55 |
| 92342 |
|
13 |
13 |
$316.81 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$290.88 |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
12 |
12 |
$192.36 |