| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
653 |
630 |
$27K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
335 |
328 |
$14K |
| V2020 |
Frames, purchases |
638 |
597 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
332 |
315 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
404 |
377 |
$6K |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
81 |
78 |
$2K |
| V2025 |
Deluxe frame |
12 |
12 |
$835.44 |
| V2106 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens |
12 |
12 |
$124.56 |