| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,272 |
1,237 |
$54K |
| V2020 |
Frames, purchases |
849 |
810 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
464 |
451 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
640 |
621 |
$8K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
144 |
138 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
52 |
51 |
$720.05 |
| 3072F |
|
45 |
44 |
$420.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$186.84 |