| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,731 |
1,718 |
$70K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,639 |
1,624 |
$66K |
| V2020 |
Frames, purchases |
3,179 |
2,993 |
$42K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,550 |
1,451 |
$30K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
817 |
805 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
156 |
139 |
$3K |
| V2750 |
Anti-reflective coating, per lens |
15 |
15 |
$365.53 |