| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
454 |
420 |
$18K |
| V2025 |
Deluxe frame |
536 |
492 |
$13K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
304 |
291 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
610 |
566 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
595 |
558 |
$7K |
| V2300 |
Sphere, trifocal, plano to plus or minus 4.00d, per lens |
41 |
40 |
$1K |
| V2755 |
U-v lens, per lens |
446 |
406 |
$915.21 |
| V2760 |
Scratch resistant coating, per lens |
441 |
402 |
$820.99 |
| V2020 |
Frames, purchases |
36 |
35 |
$553.59 |