| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
305 |
304 |
$13K |
| V2020 |
Frames, purchases |
473 |
469 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
232 |
231 |
$5K |
| 92250 |
|
53 |
52 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
115 |
114 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
44 |
43 |
$2K |
| V2025 |
Deluxe frame |
27 |
27 |
$2K |
| 92015 |
Determination of refractive state |
80 |
79 |
$1K |