| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,433 |
1,406 |
$35K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
611 |
609 |
$27K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
335 |
329 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
315 |
313 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
290 |
281 |
$8K |
| V2760 |
Scratch resistant coating, per lens |
12 |
12 |
$210.00 |