| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
10,461 |
10,188 |
$444K |
| V2025 |
Deluxe frame |
6,259 |
6,113 |
$179K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
8,897 |
8,187 |
$155K |
| V2020 |
Frames, purchases |
7,513 |
7,071 |
$116K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
9,337 |
8,495 |
$96K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,758 |
1,646 |
$53K |
| 3072F |
|
3,889 |
3,794 |
$24K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
328 |
326 |
$22K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,156 |
1,129 |
$21K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
758 |
722 |
$13K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
166 |
150 |
$9K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
180 |
179 |
$7K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
139 |
133 |
$6K |
| 92250 |
|
12 |
12 |
$511.12 |
| 92015 |
Determination of refractive state |
1,048 |
1,038 |
$210.00 |
| 92341 |
|
172 |
170 |
$90.00 |