| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological exa |
3,142 |
3,100 |
$129K |
| V2020 |
Vision svcs frames purchases |
4,276 |
4,150 |
$81K |
| V2025 |
Eyeglasses delux frames |
1,791 |
1,775 |
$81K |
| S0620 |
Routine ophthalmological exa |
1,828 |
1,814 |
$76K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,639 |
3,572 |
$74K |
| V2784 |
Lens polycarb or equal |
825 |
756 |
$25K |
| V2744 |
Tint photochromatic lens/es |
317 |
316 |
$15K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
780 |
774 |
$14K |
| V2100 |
Lens spher single plano 4.00 |
206 |
201 |
$4K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
27 |
27 |
$984.16 |
| V2107 |
Spherocylinder 4.25d/12-2d |
24 |
24 |
$388.00 |