| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
924 |
857 |
$15K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
177 |
170 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
266 |
234 |
$5K |
| V2201 |
Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens |
97 |
96 |
$2K |
| V2025 |
Deluxe frame |
31 |
30 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
26 |
26 |
$1K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
28 |
28 |
$491.66 |