| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
474 |
407 |
$16K |
| V2020 |
Frames, purchases |
634 |
540 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
350 |
279 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
93 |
82 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
36 |
36 |
$792.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
424 |
339 |
$143.00 |