| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,695 |
1,690 |
$67K |
| V2020 |
Frames, purchases |
3,202 |
3,116 |
$53K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,685 |
1,669 |
$19K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
384 |
361 |
$14K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
230 |
230 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
187 |
156 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
531 |
526 |
$6K |
| V2199 |
Not otherwise classified, single vision lens |
362 |
358 |
$6K |
| 92015 |
Determination of refractive state |
845 |
775 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
157 |
155 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
57 |
54 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
12 |
$400.00 |
| V2025 |
Deluxe frame |
16 |
14 |
$260.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$142.50 |