| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
608 |
606 |
$36K |
| V2020 |
Frames, purchases |
784 |
772 |
$17K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
211 |
211 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
364 |
363 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
269 |
269 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
56 |
56 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
15 |
15 |
$1K |