| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,085 |
2,074 |
$89K |
| V2025 |
Deluxe frame |
1,010 |
1,004 |
$55K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,213 |
1,210 |
$52K |
| V2020 |
Frames, purchases |
1,842 |
1,820 |
$34K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,677 |
1,655 |
$34K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
268 |
258 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
638 |
636 |
$17K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
184 |
184 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
121 |
119 |
$2K |