| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
414 |
402 |
$17K |
| V2020 |
Frames, purchases |
619 |
601 |
$11K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
235 |
232 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
379 |
367 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
14 |
$295.83 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
12 |
$213.56 |