| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
779 |
773 |
$33K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
628 |
622 |
$26K |
| V2020 |
Frames, purchases |
1,328 |
1,299 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
823 |
808 |
$18K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
91 |
91 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
184 |
182 |
$464.00 |