| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,493 |
1,432 |
$60K |
| V2025 |
Deluxe frame |
1,335 |
1,272 |
$34K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,401 |
1,329 |
$24K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
176 |
174 |
$7K |
| V2020 |
Frames, purchases |
216 |
211 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
150 |
150 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
52 |
51 |
$466.00 |
| 92015 |
Determination of refractive state |
33 |
33 |
$10.00 |