| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,623 |
1,527 |
$48K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
985 |
942 |
$30K |
| V2020 |
Frames, purchases |
225 |
198 |
$16K |
| 92310 |
|
81 |
71 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
98 |
87 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
32 |
25 |
$864.51 |
| 92015 |
Determination of refractive state |
334 |
291 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$0.00 |
| 92250 |
|
255 |
211 |
$0.00 |