| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,036 |
916 |
$29K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,022 |
737 |
$13K |
| V2020 |
Frames, purchases |
549 |
490 |
$8K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
291 |
249 |
$8K |
| V2025 |
Deluxe frame |
203 |
188 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$128.30 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
275 |
236 |
$97.50 |
| 92015 |
Determination of refractive state |
37 |
36 |
$13.02 |
| 1036F |
|
19 |
19 |
$0.00 |
| S0612 |
Annual gynecological examination, established patient |
28 |
28 |
$0.00 |
| 99072 |
|
773 |
708 |
$0.00 |