| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,857 |
1,719 |
$84K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,038 |
967 |
$54K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
322 |
293 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$542.64 |
| 92015 |
Determination of refractive state |
14 |
12 |
$150.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$72.00 |