| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
876 |
852 |
$80K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
542 |
527 |
$25K |
| V2020 |
Frames, purchases |
739 |
669 |
$18K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
153 |
150 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
288 |
227 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
57 |
55 |
$1K |
| 92002 |
|
18 |
18 |
$1K |
| 92015 |
Determination of refractive state |
747 |
718 |
$120.40 |