| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
437 |
397 |
$13K |
| V2020 |
Frames, purchases |
84 |
84 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
53 |
53 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
56 |
55 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
18 |
13 |
$540.00 |
| 92250 |
|
62 |
31 |
$0.00 |
| 92015 |
Determination of refractive state |
116 |
97 |
$0.00 |