| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,027 |
1,844 |
$66K |
| V2020 |
Frames, purchases |
2,572 |
2,316 |
$37K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
940 |
908 |
$25K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,343 |
1,335 |
$24K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
395 |
377 |
$16K |
| V2025 |
Deluxe frame |
281 |
280 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,275 |
1,019 |
$10K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
15 |
15 |
$633.57 |
| V2750 |
Anti-reflective coating, per lens |
14 |
14 |
$38.69 |