| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
5,064 |
4,982 |
$215K |
| V2025 |
Deluxe frame |
2,752 |
2,707 |
$162K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,861 |
2,838 |
$124K |
| V2020 |
Frames, purchases |
5,696 |
5,610 |
$104K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,903 |
4,826 |
$96K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,601 |
1,567 |
$29K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,793 |
1,751 |
$28K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
537 |
524 |
$14K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
350 |
345 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
51 |
43 |
$692.09 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
41 |
39 |
$658.56 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
19 |
19 |
$218.01 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
64 |
27 |
$0.00 |