| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
456 |
455 |
$19K |
| V2020 |
Frames, purchases |
356 |
354 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
240 |
238 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
179 |
179 |
$4K |
| V2025 |
Deluxe frame |
29 |
29 |
$2K |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
26 |
26 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
27 |
27 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
20 |
20 |
$586.00 |