| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
611 |
501 |
$25K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
279 |
276 |
$12K |
| V2020 |
Frames, purchases |
396 |
382 |
$8K |
| V2750 |
Anti-reflective coating, per lens |
221 |
217 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
290 |
286 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
226 |
223 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
16 |
14 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
51 |
43 |
$770.00 |