| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
867 |
861 |
$36K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
517 |
505 |
$21K |
| V2020 |
Frames, purchases |
1,225 |
1,199 |
$21K |
| V2025 |
Deluxe frame |
302 |
301 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
877 |
870 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
533 |
511 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
162 |
157 |
$6K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$169.32 |