| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
183 |
169 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
176 |
170 |
$7K |
| V2020 |
Frames, purchases |
210 |
197 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
189 |
180 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
126 |
114 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$233.91 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$163.18 |