| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
771 |
740 |
$32K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
436 |
420 |
$18K |
| V2020 |
Frames, purchases |
1,166 |
1,081 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
509 |
483 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
424 |
402 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
629 |
607 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
26 |
25 |
$415.20 |