| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,122 |
2,115 |
$87K |
| V2020 |
Frames, purchases |
1,013 |
926 |
$64K |
| V2025 |
Deluxe frame |
510 |
371 |
$46K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
478 |
452 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
503 |
462 |
$13K |
| 92310 |
|
142 |
140 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
69 |
55 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
30 |
25 |
$668.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$420.00 |
| 92015 |
Determination of refractive state |
2,885 |
2,823 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
605 |
387 |
$0.00 |