| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,960 |
1,936 |
$80K |
| V2020 |
Frames, purchases |
2,091 |
2,031 |
$39K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,433 |
1,407 |
$30K |
| V2025 |
Deluxe frame |
333 |
330 |
$14K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
106 |
101 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
122 |
105 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
169 |
169 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
29 |
29 |
$1K |