| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,485 |
1,418 |
$76K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
789 |
749 |
$40K |
| V2025 |
Deluxe frame |
1,156 |
1,113 |
$34K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,684 |
1,572 |
$33K |
| V2020 |
Frames, purchases |
1,217 |
1,132 |
$22K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,188 |
1,128 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
185 |
185 |
$4K |