| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
3,142 |
3,100 |
$129K |
| V2020 |
Frames, purchases |
4,276 |
4,150 |
$81K |
| V2025 |
Deluxe frame |
1,791 |
1,775 |
$81K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,828 |
1,814 |
$76K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,639 |
3,572 |
$74K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
825 |
756 |
$25K |
| V2744 |
Tint, photochromatic, per lens |
317 |
316 |
$15K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
780 |
774 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
206 |
201 |
$4K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
27 |
27 |
$984.16 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
24 |
24 |
$388.00 |