| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,458 |
1,394 |
$58K |
| 3072F |
|
1,889 |
1,808 |
$18K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
277 |
272 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
21 |
21 |
$634.90 |
| V2750 |
Anti-reflective coating, per lens |
21 |
21 |
$522.92 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$447.16 |
| V2020 |
Frames, purchases |
25 |
25 |
$345.33 |
| 92015 |
Determination of refractive state |
1,894 |
1,809 |
$0.00 |