| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,799 |
1,712 |
$72K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,397 |
1,327 |
$25K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
520 |
489 |
$20K |
| V2020 |
Frames, purchases |
1,270 |
1,179 |
$19K |
| V2025 |
Deluxe frame |
590 |
543 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
583 |
541 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
74 |
67 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
74 |
69 |
$246.63 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$234.21 |