| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,538 |
1,501 |
$64K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,396 |
1,365 |
$58K |
| V2020 |
Frames, purchases |
2,664 |
2,465 |
$38K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,447 |
1,342 |
$24K |
| 92014 |
|
430 |
394 |
$24K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,014 |
1,864 |
$22K |
| 92015 |
|
901 |
822 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
563 |
530 |
$10K |
| 92004 |
|
88 |
77 |
$5K |
| 92250 |
|
67 |
63 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
55 |
53 |
$757.82 |