| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
572 |
518 |
$22K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
523 |
475 |
$20K |
| V2020 |
Frames, purchases |
1,179 |
1,028 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
856 |
767 |
$15K |
| V2025 |
Deluxe frame |
184 |
175 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
449 |
394 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
157 |
142 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
114 |
104 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$78.02 |