| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
3,068 |
3,011 |
$131K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,367 |
2,340 |
$101K |
| V2020 |
Frames, purchases |
117 |
115 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
105 |
102 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
84 |
81 |
$19.50 |
| V2750 |
Anti-reflective coating, per lens |
78 |
75 |
$0.00 |
| 92015 |
Determination of refractive state |
16 |
16 |
$0.00 |