| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,711 |
2,663 |
$130K |
| V2020 |
Frames, purchases |
373 |
373 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
209 |
209 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
100 |
100 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
73 |
73 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
16 |
16 |
$800.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$220.00 |
| V2750 |
Anti-reflective coating, per lens |
122 |
122 |
$0.00 |