| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
649 |
632 |
$28K |
| V2020 |
Frames, purchases |
842 |
774 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
711 |
389 |
$10K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
216 |
215 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
708 |
441 |
$9K |
| 92014 |
|
12 |
12 |
$386.96 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
16 |
12 |
$227.77 |