| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
11,751 |
11,676 |
$526K |
| V2020 |
Frames, purchases |
12,487 |
12,087 |
$256K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
10,901 |
10,600 |
$250K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,198 |
1,187 |
$55K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
770 |
751 |
$34K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
228 |
225 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
131 |
130 |
$6K |
| 92015 |
Determination of refractive state |
17 |
17 |
$248.00 |
| 3072F |
|
24 |
24 |
$240.00 |