| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
968 |
957 |
$41K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,409 |
1,376 |
$28K |
| V2020 |
Frames, purchases |
1,597 |
1,545 |
$24K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
466 |
458 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
565 |
560 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
140 |
140 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
84 |
81 |
$2K |
| V2025 |
Deluxe frame |
25 |
25 |
$810.78 |
| 2022F |
|
135 |
133 |
$0.00 |
| 92015 |
Determination of refractive state |
37 |
37 |
$0.00 |