| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
396 |
389 |
$16K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
366 |
352 |
$15K |
| V2020 |
Frames, purchases |
633 |
602 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
323 |
309 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
125 |
124 |
$3K |
| 92015 |
Determination of refractive state |
12 |
12 |
$186.00 |