| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,923 |
1,922 |
$88K |
| V2025 |
Deluxe frame |
1,087 |
1,085 |
$66K |
| V2020 |
Frames, purchases |
2,185 |
2,161 |
$44K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
922 |
922 |
$41K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,644 |
1,635 |
$34K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
676 |
673 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
497 |
495 |
$9K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
141 |
141 |
$4K |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
25 |
24 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
88 |
88 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$185.09 |