| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,940 |
1,918 |
$81K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,904 |
1,888 |
$81K |
| V2020 |
Frames, purchases |
3,078 |
3,032 |
$60K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,264 |
1,252 |
$28K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
922 |
917 |
$22K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
764 |
759 |
$13K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
299 |
295 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
115 |
115 |
$2K |
| S0500 |
Disposable contact lens, per lens |
19 |
18 |
$696.00 |
| V2760 |
Scratch resistant coating, per lens |
13 |
13 |
$189.00 |
| V2799 |
Vision item or service, miscellaneous |
13 |
13 |
$95.00 |