| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
4,748 |
4,706 |
$201K |
| V2020 |
Frames, purchases |
8,882 |
8,723 |
$139K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
2,487 |
2,359 |
$129K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
8,207 |
4,582 |
$87K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,931 |
1,915 |
$82K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,415 |
2,540 |
$33K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
473 |
441 |
$32K |
| 92015 |
Determination of refractive state |
3,359 |
3,041 |
$25K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
2,210 |
1,351 |
$22K |
| 92002 |
|
390 |
353 |
$20K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
90 |
63 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
57 |
39 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
45 |
45 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
98 |
59 |
$1K |