| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,199 |
2,155 |
$92K |
| V2020 |
Frames, purchases |
3,777 |
3,530 |
$55K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,205 |
2,088 |
$41K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,299 |
3,113 |
$35K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
755 |
740 |
$32K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
928 |
859 |
$17K |
| V2025 |
Deluxe frame |
279 |
260 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
371 |
337 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
71 |
69 |
$6K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
110 |
97 |
$5K |
| V2199 |
Not otherwise classified, single vision lens |
214 |
211 |
$2K |
| 92015 |
Determination of refractive state |
123 |
118 |
$2K |
| S0592 |
Comprehensive contact lens evaluation |
14 |
14 |
$992.00 |