| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
331 |
326 |
$22K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,091 |
518 |
$11K |
| V2020 |
Frames, purchases |
622 |
555 |
$10K |
| V2025 |
Deluxe frame |
159 |
159 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
62 |
55 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
58 |
58 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
135 |
68 |
$4K |
| 92015 |
Determination of refractive state |
182 |
175 |
$2K |