| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
521 |
465 |
$15K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
302 |
300 |
$13K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
200 |
198 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
253 |
251 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
151 |
149 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
71 |
71 |
$3K |