| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
706 |
559 |
$24K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
784 |
633 |
$11K |
| V2020 |
Frames, purchases |
817 |
680 |
$11K |
| V2750 |
Anti-reflective coating, per lens |
181 |
152 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
119 |
114 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
210 |
174 |
$4K |
| V2025 |
Deluxe frame |
85 |
60 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
13 |
$523.69 |