| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
582 |
557 |
$23K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
327 |
314 |
$13K |
| V2020 |
Frames, purchases |
680 |
646 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
401 |
386 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
549 |
524 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
151 |
149 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$967.80 |
| 92015 |
Determination of refractive state |
22 |
21 |
$235.34 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$175.50 |