| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
809 |
777 |
$15K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
574 |
566 |
$10K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
217 |
211 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
141 |
138 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
254 |
243 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
78 |
78 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
354 |
281 |
$1K |
| 92015 |
Determination of refractive state |
83 |
79 |
$824.03 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$687.96 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
46 |
32 |
$291.23 |
| V2025 |
Deluxe frame |
13 |
13 |
$0.00 |