| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,131 |
1,120 |
$57K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,297 |
1,286 |
$39K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
339 |
334 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$541.96 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
14 |
14 |
$420.00 |