| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,806 |
1,802 |
$77K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,169 |
1,154 |
$48K |
| V2025 |
Deluxe frame |
1,477 |
1,475 |
$45K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,969 |
1,957 |
$38K |
| V2020 |
Frames, purchases |
2,073 |
2,055 |
$34K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
257 |
257 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
101 |
101 |
$2K |
| 92015 |
Determination of refractive state |
386 |
378 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$1K |
| 2023F |
|
47 |
42 |
$0.00 |