| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,469 |
2,388 |
$119K |
| V2020 |
Frames, purchases |
1,982 |
1,932 |
$50K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
969 |
960 |
$45K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,247 |
1,213 |
$29K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
213 |
212 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
685 |
672 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
52 |
51 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
120 |
118 |
$0.00 |