| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
260 |
250 |
$10K |
| V2020 |
Frames, purchases |
331 |
313 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
252 |
241 |
$4K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
84 |
74 |
$3K |
| V2025 |
Deluxe frame |
30 |
30 |
$897.26 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
49 |
46 |
$480.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
24 |
$470.00 |
| V2750 |
Anti-reflective coating, per lens |
15 |
14 |
$0.00 |