| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,514 |
1,508 |
$66K |
| V2020 |
Frames, purchases |
1,531 |
1,523 |
$24K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
485 |
484 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
885 |
880 |
$18K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
937 |
931 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
77 |
76 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
102 |
101 |
$2K |
| V2025 |
Deluxe frame |
46 |
46 |
$1K |
| 92015 |
Determination of refractive state |
27 |
27 |
$270.00 |