| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
819 |
714 |
$28K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
683 |
622 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,083 |
1,006 |
$16K |
| V2750 |
Anti-reflective coating, per lens |
524 |
497 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
627 |
599 |
$13K |
| V2020 |
Frames, purchases |
867 |
796 |
$11K |
| V2025 |
Deluxe frame |
188 |
185 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
50 |
50 |
$784.39 |