| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
230 |
220 |
$12K |
| V2020 |
Frames, purchases |
486 |
454 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
156 |
151 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
101 |
98 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
30 |
29 |
$2K |
| 92014 |
|
12 |
12 |
$1K |
| 92012 |
|
14 |
13 |
$941.17 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
33 |
32 |
$726.10 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$345.90 |
| 92015 |
|
12 |
12 |
$187.52 |