| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,192 |
1,167 |
$75K |
| V2020 |
Frames, purchases |
2,098 |
2,010 |
$65K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,216 |
1,181 |
$34K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
299 |
292 |
$18K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,586 |
1,555 |
$14K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
310 |
303 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
303 |
295 |
$8K |