| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
830 |
698 |
$23K |
| V2020 |
Frames, purchases |
708 |
636 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
472 |
438 |
$8K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
175 |
145 |
$5K |
| V2025 |
Deluxe frame |
51 |
51 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
117 |
97 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
45 |
41 |
$628.97 |
| 92015 |
Determination of refractive state |
1,031 |
859 |
$0.00 |