| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,532 |
2,448 |
$104K |
| V2020 |
Frames, purchases |
4,801 |
4,412 |
$77K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,047 |
2,578 |
$56K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,212 |
1,178 |
$50K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
188 |
184 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
568 |
349 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
559 |
312 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
37 |
37 |
$4K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
15 |
15 |
$604.79 |
| 92015 |
Determination of refractive state |
605 |
548 |
$42.56 |