| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,168 |
2,080 |
$189K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,028 |
994 |
$67K |
| V2020 |
Frames, purchases |
2,973 |
2,680 |
$56K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
326 |
320 |
$30K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,266 |
1,131 |
$18K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
349 |
263 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
399 |
371 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
115 |
109 |
$3K |
| 92250 |
|
30 |
24 |
$775.33 |
| 92015 |
Determination of refractive state |
2,971 |
2,912 |
$602.00 |
| V2756 |
Eye glass case |
38 |
38 |
$34.56 |