| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological exa |
5,064 |
4,982 |
$215K |
| V2025 |
Eyeglasses delux frames |
2,752 |
2,707 |
$162K |
| S0620 |
Routine ophthalmological exa |
2,861 |
2,838 |
$124K |
| V2020 |
Vision svcs frames purchases |
5,696 |
5,610 |
$104K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
4,903 |
4,826 |
$96K |
| V2100 |
Lens spher single plano 4.00 |
1,601 |
1,567 |
$29K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,793 |
1,751 |
$28K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
537 |
524 |
$14K |
| V2107 |
Spherocylinder 4.25d/12-2d |
350 |
345 |
$6K |
| V2784 |
Lens polycarb or equal |
51 |
43 |
$692.09 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
41 |
39 |
$658.56 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
19 |
19 |
$218.01 |
| 92340 |
|
64 |
27 |
$0.00 |