| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,025 |
1,015 |
$43K |
| V2020 |
Frames, purchases |
1,501 |
1,459 |
$38K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,448 |
1,384 |
$33K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
655 |
649 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
245 |
245 |
$854.50 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
919 |
890 |
$699.00 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |