| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,086 |
2,068 |
$90K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,572 |
1,563 |
$68K |
| V2025 |
Deluxe frame |
1,628 |
1,603 |
$48K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,739 |
1,707 |
$33K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,726 |
1,694 |
$20K |
| V2020 |
Frames, purchases |
13 |
13 |
$240.00 |
| 92015 |
Determination of refractive state |
14 |
12 |
$90.00 |