| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,001 |
2,000 |
$83K |
| V2020 |
Frames, purchases |
3,276 |
3,270 |
$76K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,056 |
3,047 |
$51K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
911 |
911 |
$30K |
| 92341 |
|
787 |
785 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
808 |
806 |
$12K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
279 |
278 |
$7K |
| 92015 |
Determination of refractive state |
577 |
569 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
195 |
195 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
25 |
25 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$650.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
49 |
49 |
$621.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
97 |
97 |
$582.00 |