| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,763 |
1,708 |
$72K |
| V2020 |
Frames, purchases |
2,526 |
2,359 |
$38K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,708 |
1,619 |
$33K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
581 |
567 |
$24K |
| V2025 |
Deluxe frame |
1,472 |
1,358 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,240 |
1,118 |
$13K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
219 |
186 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
473 |
419 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
270 |
262 |
$7K |
| V2750 |
Anti-reflective coating, per lens |
123 |
114 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
128 |
126 |
$2K |
| 92015 |
Determination of refractive state |
383 |
342 |
$946.72 |
| V2755 |
U-v lens, per lens |
269 |
247 |
$821.32 |
| CP002 |
|
52 |
51 |
$499.80 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
110 |
101 |
$376.90 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
16 |
14 |
$259.11 |
| 3072F |
|
105 |
105 |
$0.00 |