| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
424 |
195 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
353 |
152 |
$16K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
251 |
124 |
$16K |
| V2020 |
Frames, purchases |
633 |
295 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
462 |
209 |
$8K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
302 |
125 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
62 |
25 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
42 |
13 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$1K |
| 92015 |
Determination of refractive state |
75 |
75 |
$938.25 |
| 92341 |
|
24 |
12 |
$480.00 |