| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,613 |
1,593 |
$69K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,184 |
1,165 |
$50K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
306 |
303 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
445 |
435 |
$8K |
| V2020 |
Frames, purchases |
512 |
497 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
416 |
408 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
272 |
266 |
$4K |
| 92015 |
Determination of refractive state |
691 |
679 |
$3K |
| 92082 |
|
52 |
52 |
$2K |
| 92310 |
|
12 |
12 |
$204.80 |