| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,010 |
1,950 |
$83K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,879 |
1,786 |
$75K |
| V2025 |
Deluxe frame |
1,685 |
1,637 |
$47K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,068 |
1,036 |
$19K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
459 |
405 |
$12K |
| V2020 |
Frames, purchases |
740 |
694 |
$11K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
638 |
615 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
859 |
821 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
239 |
222 |
$4K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
196 |
189 |
$3K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
145 |
137 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
24 |
$2K |
| 92015 |
Determination of refractive state |
150 |
138 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
42 |
41 |
$658.31 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
15 |
15 |
$542.88 |
| V2750 |
Anti-reflective coating, per lens |
16 |
14 |
$37.62 |