| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
491 |
483 |
$31K |
| V2020 |
Frames, purchases |
922 |
897 |
$27K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
153 |
145 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
42 |
38 |
$538.82 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
48 |
45 |
$80.00 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
14 |
14 |
$0.00 |