| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
739 |
724 |
$36K |
| V2025 |
Deluxe frame |
239 |
234 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
508 |
499 |
$10K |
| V2020 |
Frames, purchases |
305 |
299 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
29 |
28 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
26 |
$338.00 |
| 1036F |
|
76 |
54 |
$0.00 |