| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
166 |
165 |
$4K |
| V2020 |
Frames, purchases |
139 |
138 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
227 |
226 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
24 |
24 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
13 |
13 |
$638.69 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
27 |
27 |
$542.87 |
| 92015 |
Determination of refractive state |
66 |
66 |
$482.08 |