| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,668 |
1,639 |
$69K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,333 |
1,284 |
$53K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,562 |
1,495 |
$29K |
| V2020 |
Frames, purchases |
1,577 |
1,507 |
$23K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,452 |
1,384 |
$17K |
| 92004 |
|
957 |
920 |
$5K |
| V2750 |
Anti-reflective coating, per lens |
405 |
385 |
$5K |
| 92014 |
|
1,067 |
1,045 |
$4K |
| 92015 |
|
2,040 |
1,971 |
$1K |