| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
4,085 |
3,945 |
$164K |
| V2020 |
Frames, purchases |
6,762 |
6,255 |
$91K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,192 |
2,124 |
$89K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,675 |
4,398 |
$88K |
| V2025 |
Deluxe frame |
5,780 |
5,336 |
$49K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,024 |
2,731 |
$31K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,440 |
1,298 |
$22K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
469 |
426 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
683 |
656 |
$11K |
| V2750 |
Anti-reflective coating, per lens |
213 |
201 |
$3K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
68 |
65 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
93 |
79 |
$2K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
525 |
476 |
$1K |
| 92015 |
Determination of refractive state |
1,001 |
820 |
$1K |
| 92002 |
|
17 |
13 |
$821.76 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
49 |
46 |
$787.50 |
| V2755 |
U-v lens, per lens |
218 |
200 |
$757.09 |