| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,860 |
4,655 |
$132K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,176 |
2,142 |
$111K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,132 |
2,095 |
$104K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,695 |
2,599 |
$56K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
440 |
427 |
$9K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
101 |
97 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
271 |
266 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
38 |
37 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$1K |
| 92060 |
|
25 |
25 |
$1K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
24 |
24 |
$528.00 |
| 92015 |
Determination of refractive state |
285 |
276 |
$270.26 |