| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,749 |
2,726 |
$116K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,788 |
4,677 |
$97K |
| V2020 |
Frames, purchases |
5,278 |
5,135 |
$83K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,644 |
1,631 |
$70K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,624 |
1,571 |
$19K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$438.75 |
| 92015 |
Determination of refractive state |
12 |
12 |
$0.00 |