| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,156 |
1,149 |
$47K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
719 |
715 |
$29K |
| V2020 |
Frames, purchases |
797 |
797 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
749 |
749 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
855 |
855 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
31 |
31 |
$517.00 |