| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,596 |
1,595 |
$83K |
| V2020 |
Frames, purchases |
2,022 |
1,995 |
$51K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
944 |
939 |
$20K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
307 |
307 |
$15K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
143 |
142 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
14 |
$253.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$209.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$0.00 |