| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
640 |
564 |
$23K |
| V2020 |
Frames, purchases |
1,322 |
1,184 |
$20K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
284 |
274 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
833 |
495 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
289 |
209 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
12 |
12 |
$0.00 |