| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
643 |
635 |
$16K |
| V2020 |
Frames, purchases |
870 |
829 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
510 |
506 |
$11K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
206 |
206 |
$8K |
| V2025 |
Deluxe frame |
69 |
69 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
227 |
193 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
100 |
99 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
27 |
27 |
$1K |
| V2799 |
Vision item or service, miscellaneous |
14 |
14 |
$45.00 |
| 92015 |
Determination of refractive state |
410 |
409 |
$0.00 |