| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,131 |
1,937 |
$31K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
559 |
552 |
$27K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,079 |
1,035 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,433 |
1,105 |
$20K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
461 |
458 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,418 |
1,035 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
255 |
244 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
132 |
120 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
46 |
46 |
$2K |
| 92341 |
|
52 |
52 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
108 |
89 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
40 |
26 |
$417.50 |
| 92015 |
Determination of refractive state |
856 |
794 |
$0.00 |