| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
332 |
331 |
$10K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
209 |
208 |
$4K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
54 |
54 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
197 |
197 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
41 |
41 |
$2K |
| 92341 |
|
15 |
15 |
$321.72 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
15 |
$151.58 |