| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
988 |
974 |
$43K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
831 |
826 |
$36K |
| V2020 |
Frames, purchases |
1,410 |
1,399 |
$34K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
866 |
862 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
681 |
678 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
291 |
289 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
168 |
167 |
$3K |