| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
924 |
922 |
$81K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
461 |
460 |
$40K |
| V2020 |
Frames, purchases |
1,534 |
1,507 |
$39K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
901 |
887 |
$37K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
275 |
273 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
661 |
652 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
140 |
139 |
$6K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
28 |
28 |
$1K |