| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
742 |
737 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
288 |
287 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
244 |
152 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
62 |
62 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
154 |
90 |
$1K |
| 92250 |
|
12 |
12 |
$573.90 |
| V2755 |
U-v lens, per lens |
176 |
88 |
$0.00 |