| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
463 |
445 |
$19K |
| V2020 |
Frames, purchases |
1,035 |
1,018 |
$19K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
253 |
241 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
110 |
109 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
97 |
97 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
84 |
82 |
$2K |