| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,783 |
1,748 |
$68K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,061 |
1,035 |
$44K |
| V2020 |
Frames, purchases |
2,402 |
2,199 |
$39K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,052 |
969 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
851 |
790 |
$14K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$603.12 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
12 |
$156.02 |
| 92310 |
|
26 |
24 |
$64.00 |