| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,400 |
1,373 |
$63K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,058 |
1,007 |
$42K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
741 |
725 |
$31K |
| V2020 |
Frames, purchases |
543 |
526 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
855 |
825 |
$20K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
715 |
670 |
$16K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
13 |
$309.21 |
| 92015 |
Determination of refractive state |
13 |
12 |
$93.00 |