| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
4,036 |
3,906 |
$172K |
| V2025 |
Deluxe frame |
1,919 |
1,866 |
$87K |
| V2020 |
Frames, purchases |
4,699 |
4,464 |
$77K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,717 |
3,580 |
$71K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,444 |
1,395 |
$60K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,415 |
1,363 |
$43K |
| V2744 |
Tint, photochromatic, per lens |
412 |
408 |
$19K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,138 |
1,088 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
217 |
211 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
119 |
115 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
69 |
57 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
54 |
53 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
15 |
15 |
$675.00 |