| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,072 |
1,039 |
$44K |
| V2020 |
Frames, purchases |
530 |
502 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
343 |
328 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
29 |
26 |
$965.75 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
64 |
52 |
$874.50 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$405.00 |
| V2025 |
Deluxe frame |
13 |
13 |
$238.00 |
| 92015 |
Determination of refractive state |
54 |
42 |
$176.28 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$156.00 |
| V2750 |
Anti-reflective coating, per lens |
18 |
15 |
$69.28 |