| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
566 |
561 |
$17K |
| V2020 |
Frames, purchases |
231 |
226 |
$12K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
171 |
166 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
102 |
98 |
$3K |
| V2025 |
Deluxe frame |
14 |
13 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$482.40 |
| 92015 |
Determination of refractive state |
53 |
53 |
$435.52 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$328.00 |