| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
838 |
819 |
$18K |
| V2020 |
Frames, purchases |
1,046 |
1,030 |
$18K |
| 92015 |
Determination of refractive state |
529 |
510 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
125 |
119 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
386 |
376 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
60 |
56 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
30 |
29 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
32 |
32 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
15 |
$866.40 |