| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,503 |
1,479 |
$24K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
462 |
456 |
$19K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
414 |
409 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
591 |
583 |
$12K |
| V2025 |
Deluxe frame |
13 |
13 |
$435.08 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$231.00 |