| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,245 |
1,228 |
$53K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
478 |
467 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
675 |
648 |
$13K |
| V2025 |
Deluxe frame |
478 |
463 |
$11K |
| V2020 |
Frames, purchases |
595 |
574 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
463 |
451 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
301 |
292 |
$6K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
141 |
137 |
$2K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
30 |
29 |
$2K |