| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,109 |
1,062 |
$72K |
| V2025 |
Deluxe frame |
1,330 |
1,261 |
$60K |
| V2020 |
Frames, purchases |
1,912 |
1,781 |
$55K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,497 |
2,316 |
$42K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,673 |
1,549 |
$39K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
523 |
518 |
$36K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
386 |
381 |
$31K |
| V2750 |
Anti-reflective coating, per lens |
1,428 |
1,350 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
443 |
414 |
$12K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
510 |
481 |
$12K |
| 92015 |
Determination of refractive state |
909 |
886 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
66 |
64 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
75 |
71 |
$3K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
58 |
50 |
$1K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
43 |
42 |
$772.76 |
| 92250 |
|
22 |
22 |
$755.60 |
| V2744 |
Tint, photochromatic, per lens |
19 |
17 |
$427.31 |
| V2799 |
Vision item or service, miscellaneous |
18 |
18 |
$64.09 |