| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
3,227 |
3,181 |
$138K |
| V2020 |
Frames, purchases |
5,034 |
4,905 |
$92K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,833 |
1,803 |
$77K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,043 |
2,969 |
$56K |
| V2025 |
Deluxe frame |
757 |
749 |
$45K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,262 |
2,169 |
$45K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
151 |
149 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
352 |
340 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
28 |
25 |
$1K |
| 92015 |
Determination of refractive state |
136 |
130 |
$402.92 |
| V2750 |
Anti-reflective coating, per lens |
34 |
33 |
$249.37 |