| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
877 |
860 |
$41K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
506 |
502 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
134 |
132 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
103 |
101 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
39 |
39 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$362.84 |
| V2760 |
Scratch resistant coating, per lens |
12 |
12 |
$120.54 |