| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
560 |
559 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
212 |
212 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
149 |
149 |
$9K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
155 |
155 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
90 |
90 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
174 |
174 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
123 |
123 |
$7K |