| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
332 |
330 |
$14K |
| V2025 |
Deluxe frame |
186 |
186 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
235 |
232 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
271 |
270 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
109 |
109 |
$5K |
| V2020 |
Frames, purchases |
162 |
162 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$179.43 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$165.75 |
| 92015 |
Determination of refractive state |
487 |
485 |
$15.50 |