| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,148 |
1,128 |
$44K |
| V2020 |
Frames, purchases |
1,768 |
1,736 |
$26K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,195 |
1,175 |
$25K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
348 |
344 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
690 |
677 |
$6K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
157 |
151 |
$5K |
| V2760 |
Scratch resistant coating, per lens |
51 |
51 |
$0.00 |