| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
733 |
722 |
$16K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
383 |
238 |
$11K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
281 |
234 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
255 |
252 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
189 |
181 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
203 |
203 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$1K |
| 92015 |
Determination of refractive state |
29 |
29 |
$451.94 |