| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
741 |
731 |
$38K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
334 |
330 |
$9K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
233 |
230 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
129 |
126 |
$4K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
132 |
128 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
175 |
173 |
$2K |
| 92015 |
Determination of refractive state |
15 |
15 |
$0.00 |