| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
919 |
882 |
$39K |
| V2750 |
Anti-reflective coating, per lens |
292 |
273 |
$4K |
| V2020 |
Frames, purchases |
203 |
193 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
282 |
264 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
47 |
46 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
104 |
92 |
$2K |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
26 |
26 |
$1K |