| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,018 |
863 |
$36K |
| V2020 |
Frames, purchases |
1,152 |
1,077 |
$15K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
305 |
272 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
717 |
675 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
348 |
302 |
$6K |
| V2025 |
Deluxe frame |
123 |
106 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
238 |
219 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
84 |
81 |
$2K |
| 92015 |
Determination of refractive state |
135 |
111 |
$269.30 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
34 |
16 |
$135.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
15 |
13 |
$0.00 |