| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
222 |
216 |
$9K |
| V2020 |
Frames, purchases |
298 |
269 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
168 |
157 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
129 |
115 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
31 |
29 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
15 |
12 |
$209.18 |