| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
393 |
382 |
$16K |
| V2020 |
Frames, purchases |
813 |
778 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
432 |
414 |
$8K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
180 |
175 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
73 |
72 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
27 |
27 |
$417.78 |