| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
337 |
321 |
$9K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
201 |
195 |
$8K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
176 |
169 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
337 |
324 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
186 |
173 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
80 |
78 |
$1K |