| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,434 |
1,975 |
$89K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,116 |
1,042 |
$51K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,072 |
994 |
$48K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,170 |
1,761 |
$37K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,887 |
1,549 |
$26K |
| 92250 |
|
34 |
30 |
$2K |
| V2025 |
Deluxe frame |
15 |
15 |
$789.00 |
| 92015 |
Determination of refractive state |
50 |
43 |
$559.66 |
| V2750 |
Anti-reflective coating, per lens |
32 |
26 |
$0.00 |