| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,576 |
1,178 |
$140K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
777 |
583 |
$9K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
208 |
207 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
121 |
120 |
$5K |
| V2500 |
Contact lens, pmma, spherical, per lens |
64 |
38 |
$4K |
| 92015 |
Determination of refractive state |
221 |
220 |
$994.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$874.21 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
15 |
15 |
$150.00 |