| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,015 |
1,955 |
$85K |
| V2020 |
Frames, purchases |
3,391 |
3,210 |
$68K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,545 |
1,505 |
$66K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,882 |
2,768 |
$59K |
| V2025 |
Deluxe frame |
533 |
524 |
$33K |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
527 |
521 |
$26K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
17 |
16 |
$351.20 |
| V2756 |
Eye glass case |
21 |
20 |
$0.00 |