| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
5,018 |
4,947 |
$249K |
| V2020 |
Frames, purchases |
7,466 |
7,289 |
$215K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,679 |
2,631 |
$129K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,099 |
3,977 |
$82K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,248 |
1,211 |
$24K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
906 |
888 |
$18K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
252 |
243 |
$5K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
227 |
215 |
$4K |
| V2025 |
Deluxe frame |
58 |
58 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
210 |
209 |
$2K |
| 92250 |
|
14 |
14 |
$705.01 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
27 |
27 |
$572.00 |