| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
254 |
222 |
$19K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
325 |
266 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
92 |
63 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
24 |
24 |
$969.37 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
27 |
24 |
$858.66 |