| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
433 |
433 |
$13K |
| V2020 |
Frames, purchases |
692 |
688 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
486 |
484 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
613 |
610 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
132 |
132 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
99 |
99 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
101 |
100 |
$2K |
| V2025 |
Deluxe frame |
48 |
48 |
$906.00 |
| 92015 |
Determination of refractive state |
630 |
630 |
$0.00 |