| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,192 |
1,180 |
$24K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
215 |
214 |
$13K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
177 |
176 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
221 |
220 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
161 |
159 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$250.60 |