| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
3,783 |
3,657 |
$159K |
| V2020 |
Frames, purchases |
6,681 |
6,394 |
$132K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,136 |
2,075 |
$90K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,751 |
2,647 |
$63K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
943 |
890 |
$20K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
801 |
720 |
$13K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
472 |
451 |
$9K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
14 |
14 |
$352.30 |