| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
698 |
684 |
$64K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
834 |
829 |
$29K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
644 |
642 |
$22K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
157 |
155 |
$2K |
| 92250 |
|
31 |
31 |
$2K |
| 92310 |
|
43 |
43 |
$1K |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
12 |
12 |
$778.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$398.48 |