| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
399 |
392 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
138 |
69 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
47 |
47 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
42 |
40 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
14 |
14 |
$560.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
763 |
377 |
$0.00 |