| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,330 |
4,282 |
$88K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,610 |
2,587 |
$48K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
982 |
979 |
$40K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
617 |
617 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
796 |
790 |
$18K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
932 |
921 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
473 |
469 |
$8K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
14 |
14 |
$355.96 |