| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,512 |
1,385 |
$454K |
| V2020 |
Frames, purchases |
453 |
416 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
302 |
285 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
662 |
599 |
$840.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
106 |
87 |
$426.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
28 |
$45.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
13 |
$13.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
27 |
$0.00 |
| 92015 |
Determination of refractive state |
132 |
109 |
$0.00 |