| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
641 |
561 |
$14K |
| V2020 |
Frames, purchases |
647 |
563 |
$11K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
216 |
207 |
$10K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
132 |
124 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
45 |
32 |
$2K |
| 92015 |
Determination of refractive state |
240 |
211 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
296 |
257 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
17 |
12 |
$785.84 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
13 |
$614.64 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
46 |
37 |
$522.26 |