| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,023 |
965 |
$38K |
| V2020 |
Frames, purchases |
1,639 |
1,515 |
$23K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,052 |
982 |
$21K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
499 |
491 |
$21K |
| V2025 |
Deluxe frame |
1,506 |
1,393 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
318 |
297 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
451 |
409 |
$5K |
| 92012 |
|
14 |
14 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
43 |
43 |
$761.08 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
17 |
16 |
$317.22 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
14 |
12 |
$44.76 |
| 92015 |
|
45 |
45 |
$0.00 |