| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
948 |
943 |
$43K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
817 |
810 |
$35K |
| V2020 |
Frames, purchases |
1,491 |
1,475 |
$33K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
725 |
719 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
665 |
658 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
255 |
252 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$205.61 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$154.47 |
| 3072F |
|
198 |
190 |
$0.00 |
| 92015 |
Determination of refractive state |
103 |
102 |
$0.00 |