| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,323 |
4,190 |
$122K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,270 |
2,220 |
$106K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,901 |
1,865 |
$87K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,436 |
2,378 |
$49K |
| 92004 |
|
269 |
253 |
$28K |
| 92014 |
|
184 |
175 |
$16K |
| 92012 |
|
90 |
81 |
$6K |
| 92015 |
|
827 |
781 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
216 |
206 |
$4K |
| V2025 |
Deluxe frame |
18 |
17 |
$704.01 |
| 92060 |
|
12 |
12 |
$495.09 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
12 |
$329.11 |