| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
813 |
750 |
$31K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
95 |
91 |
$4K |
| V2020 |
Frames, purchases |
110 |
101 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
125 |
102 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
109 |
103 |
$792.00 |
| 92015 |
Determination of refractive state |
641 |
554 |
$170.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$67.50 |