| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
726 |
708 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
318 |
310 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
42 |
42 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
39 |
38 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
494 |
480 |
$2K |
| 92015 |
Determination of refractive state |
138 |
131 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
12 |
$175.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
12 |
$154.00 |
| V2799 |
Vision item or service, miscellaneous |
19 |
14 |
$34.00 |