| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,526 |
1,435 |
$45K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
961 |
925 |
$43K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
661 |
642 |
$29K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,369 |
763 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
769 |
435 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
172 |
108 |
$2K |
| 92015 |
Determination of refractive state |
1,290 |
1,242 |
$193.58 |