| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,577 |
1,569 |
$79K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,167 |
1,163 |
$58K |
| V2020 |
Frames, purchases |
1,628 |
1,625 |
$53K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
613 |
613 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
518 |
513 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,438 |
1,432 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
83 |
83 |
$2K |