| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,697 |
1,635 |
$840.00 |
| V2020 |
Frames, purchases |
3,709 |
3,670 |
$336.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,404 |
1,369 |
$144.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
243 |
241 |
$81.20 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,141 |
1,138 |
$0.00 |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
283 |
279 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
39 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
390 |
390 |
$0.00 |